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

An Evaluation of the NANDA International, Inc., Diagnostic Classification Among Spanish Nurses: A Cross-Sectional Study

Background/Objectives: The NANDA International, Inc., (NANDA-I) diagnostic classification is the most widely used standardized nursing language internationally. The EVALUAN-I tool was developed to evaluate the NANDA-I diagnostic classification. The aim was to analyze the use of the NANDA-I diagnostic classification among Spanish nurses and assess its correlation with sociodemographic characteristics. Methods: A cross-sectional study was conducted on a non-probabilistic sample of Spanish nurses working in clinical, management, and academic settings using the EVALUAN-I tool (September 2019-December 2020). The analysis was conducted using R® (version 3.6.3, Lavaan package; R Core Team, 2020), with statistical significance set at p < 0.05. This study was approved by the Research Ethics Committee (2019-190-1). Results: A total of 483 responses were obtained. There was a correlation between the intensity of use of NANDA-I and its application in practice (polychoric correlation = 0.50; p < 0.001). Nurses with a PhD degree considered nursing diagnoses to be less evidence-based (p = 0.037) but more useful (p = 0.035). Academic and research nurses stated that NANDA-I was more useful (p = 0.007), even for exclusive responsibilities (p = 0.034), and that it provided greater significance to diagnoses (p = 0.0012). Conclusions: NANDA-I is the most widely used standardized nursing language in Spain. Nurses' academic qualifications and work environment significantly influence their perceptions and use of NANDA-I. Advanced education fosters a critical yet positive perspective, highlighting a relationship between the intensity of its use, its application in clinical practice, and the nurse's educational background. Tools such as EVALUAN-I promote its integration and evidence-based practice, but challenges remain in improving perceptions, scientific evidence, and visibility in electronic health records to enhance its clinical impact and nursing recognition.

Application and assessment of NNN linkages in liver transplant postoperative care: a prospective study

BACKGROUND

Standardized nursing frameworks are widely used to unify nursing practices and enhance patient outcomes, but their application in liver transplantation is still limited. This study evaluates the use of NANDA-I, NOC, and NIC linkages in the perioperative care of liver transplant recipients, aiming to inform future nursing practice improvements.

METHODS

This prospective observational cohort study (December 2022-August 2023) included 44 liver transplant recipients using consecutive sampling. The Delphi method refined the NANDA-I, NOC, and NIC (NNN) linkage framework to 15 nursing diagnoses, 42 outcomes, and 106 interventions. Postoperative NOC indicators were assessed on surgery day and postoperative days 3, 7, 14, and at discharge. One-way repeated measures ANOVA, with Greenhouse-Geisser correction for sphericity violations, analyzed the indicators.

RESULTS

Twelve nursing diagnoses had a 100% usage rate, with an average intervention usage rate of 96.59%. Nine diagnoses showed consistent improvement in NOC scores across four time points, with significant differences (P < 0.008). In contrast, five diagnoses displayed fluctuating scores, highlighting the need for targeted interventions.

CONCLUSIONS

The NNN linkages effectively tracked postoperative changes and guided care for liver transplant patients. The findings support refining nursing care protocols to address fluctuating outcomes and improve patient recovery.

Exploring the nexus between the standardized nursing terminologies and the unfinished nursing care phenomenon: An empty systematic review

PURPOSE

To identify and synthesize evidence regarding the documented relationship between the standardized nursing terminologies and the unfinished nursing care phenomenon.

DATA SOURCES

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete databases were last consulted on November 27, 2023. The review included primary quantitative studies that reported an association between recognized standardized nursing terminologies and unfinished nursing care. Two researchers completedtitle and abstract and full-text screening.

DATA SYNTHESIS

Our search identified 149 citations. A full-text review of one paper was undertaken. No studies met our inclusion criteria. We report an empty review.

CONCLUSIONS

Standardized nursing terminologies and Unfinished Care are two sides of the same coin: despite their potential commonalities, no studies have documented their potential links. Digital systems, such as electronic health records and decision support systems, could foster this linkage.

IMPLICATIONS FOR NURSING PRACTICE

This review suggests that linking the conceptual frameworks can promote the diffusion of standardized nursing terminologies in clinical practice and increase accuracy in the measurement of Unfinished Care. This synergy could promote the contribution of nursing knowledge to patient care, nursing visibility, and be beneficial to clinical nurses, managers, and healthcare systems to international level.

Utilization and psychometric properties of Quality of documentation of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO): A scoping review

AIMS

To summarize studies using the quality of diagnoses, interventions, and outcomes (Q-DIO) and to evaluate measurement properties of different Q-DIO translations/versions. This tool assesses the quality of nursing diagnoses, interventions, and outcomes documented in nursing practice.

DESIGN

A scoping review was carried out by using the updated methodology for scoping reviews of the Joanna Briggs Institute.

METHODS

The characteristics of different Q-DIO versions were summarized, and the methodological quality and measurement properties of the instrument(s) were assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology.

DATA SOURCES

In May 2024, searches across five databases and sources of gray literature were performed.

RESULTS

Out of 14,192 articles, 35 were deemed relevant, with 12 studies included in the COSMIN analysis. Based on the evaluation results, six versions of the Q-DIO were recommended for immediate use, and one was identified as pending further validation studies before having potential for recommendation.

CONCLUSIONS

This review underscores the extensive translation, adaptation, and validation of Q-DIO instruments across various languages and cultural contexts, emphasizing their global significance and effectiveness in nursing practice. These instruments demonstrate robust psychometric properties, especially in content validity and reliability.

IMPACT

This scoping review sheds light on the existing knowledge, application, and validity of the Q-DIO, offering suggestions for its improvement. The results could assist nurse educators, managers, and researchers in effectively using the tool.

REPORTING METHOD

This study was reported following the guidelines provided by the PRISMA-ScR.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Improving the quality of nursing care through standardized nursing languages: Call to action across European countries

BACKGROUND

Standardized Nursing Languages (SNLs) have enabled nursing assessments and care to be better documented and visible in electronic health records (EHRs). However, its implementation is challenging and heterogeneous across clinical settings. This study aimed to demonstrate the challenges experienced by members of a European nursing organization, ACENDIO, in implementing SNLs in documentation systems across countries and offer recommendations about its use.

MATERIAL AND METHODS

The study was executed in two phases. First, an online survey was distributed among ACENDIO members. Second, members participated in two expert panels. Discussions were recorded, and thematic analysis was performed to formulate challenges and recommendations on the use of SNLs.

RESULTS

The findings highlight that nurses across Europe are faced with several issues with current documentation systems in clinical settings, limited education on SNLs, and challenges in research on SNLs. Nurses, managers, vendors, educators and researchers should work closely together to face the challenges in the implementation of SNLs in electronic documentation systems.

CONCLUSION

To fully utilize the beneficial effects of the use of SNLs, the call to action is to develop comprehensive collaborations of nursing practice, education, and research.

Use of Standardized Nursing Terminologies to Capture Social Determinants of Health Data: An Integrative Review

Addressing social determinants of health in nursing care is important for improving health outcomes and reducing health inequities. Using standardized nursing terminologies to capture this information generates sharable data that can be used to achieve these goals and create new knowledge. The purpose of this integrative review was to examine use of standardized nursing terminologies for collecting social determinants of health data in nursing research and practice. The CINAHL, MEDLINE, and Web of Science databases were searched using the terms "social determinants of health" [and] "nursing" [and] "standardized terminology" or names for each of the 12 American Nurses Association-approved terminologies. Limiters included peer-reviewed and English language. After removal of duplicates, 120 articles were found and screened for relevance and quality using a three-step process. This yielded a final sample of seven articles. Article data were extracted and analyzed for themes. In all articles, retrospective, observational, or secondary analysis research designs were used to analyze previously collected data from large, deidentified datasets or research studies. The Omaha System was the only standardized nursing terminology represented in the sample. All operational definitions of social determinants of health included behavioral items. In most studies, a social determinants of health index score was calculated, and data were analyzed using descriptive statistics and visualization methods. Results reported across the articles were diverse; some themes were identified. This review revealed published literature on this topic is limited. More quality improvement and multisite studies that examine the use of standardized nursing terminologies by nurses to collect and use social determinants of health data are needed.

Nursing diagnoses related to cardiovascular function in primary care: A scoping review: Diagnósticos de enfermagem relacionados a função cardiovascular na atenção primária: Scoping review

OBJECTIVE

To map nursing diagnoses related to cardiovascular function reported in studies involving patients in primary care.

METHOD

A scoping review follows JBI guidelines. Literature searches were conducted from March to May 2024. Studies included focused on nursing diagnoses for adults and older adult patients with cardiovascular conditions in primary care settings. Results were systematically presented in tables and narratively.

FINDINGS

Among the 12 included studies, the most prevalent diagnosis was "noncompliance" (00079), removed from NANDA-I in 2017. Sixteen other diagnoses were identified, indicating a broader clinical profile of individuals with cardiovascular health issues in primary care. Most studies involved patients with hypertension in Brazil.

CONCLUSIONS

Key nursing diagnoses for patients with cardiovascular conditions in primary care were identified. Ineffective health management emerged as a common characteristic among this population.

IMPLICATIONS FOR NURSING PRACTICE

Identifying prevalent diagnoses allows nurses to reinforce their commitment to managing cardiovascular conditions, improve care plans, and generate practice indicators for services, thus enhancing the quality of care provided.

Nursing interventions for the proposed nursing diagnosis of puerperal fatigue: An integrative review

INTRODUCTION

The postpartum period is considered a phase of many physiological and hormonal changes that affect the individual. Fatigue is something present and can influence the postpartum woman in a negative way. In this way, the nurse has an essential role, and the nursing process can be used to establish an efficient care plan.

OBJECTIVE

To present the main nursing interventions and activities of the nursing diagnosis (ND) fatigue (00093) in individuals/people in the immediate postpartum period obtained through an integrative literature review and correlate with the proposed ND puerperal fatigue/excessive burden of fatigue in the postpartum period.

METHODS

Integrative literature review, carried out in the databases Cochrane, Scopus and Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science (WoS), Virtual Health Library (VHL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL), following rigorous methodological standards.

RESULTS

Six articles were included that identified the main nursing interventions related to the proposed ND puerperal fatigue.

CONCLUSIONS

The integrative review highlighted the main nursing interventions and activities, and this study will be the basis for the next stages of the validation process for the ND puerperal fatigue/excessive fatigue in the postpartum period.

IMPLICATIONS FOR NURSING PRACTICE

This work can help nurses in clinical practice establish an efficient care plan through the most accurate nursing interventions and thus improve the quality of nursing services.

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.

Evaluating the validity of the nursing statements algorithmically generated based on the International Classifications of Nursing Practice for respiratory nursing care using large language models

OBJECTIVE

This study aims to facilitate the creation of quality standardized nursing statements in South Korea's hospitals using algorithmic generation based on the International Classifications of Nursing Practice (ICNP) and evaluation through Large Language Models.

MATERIALS AND METHODS

We algorithmically generated 15 972 statements related to acute respiratory care using 117 concepts and concept composition models of ICNP. Human reviewers, Generative Pre-trained Transformers 4.0 (GPT-4.0), and Bio_Clinical Bidirectional Encoder Representations from Transformers (BERT) evaluated the generated statements for validity. The evaluation by GPT-4.0 and Bio_ClinicalBERT was conducted with and without contextual information and training.

RESULTS

Of the generated statements, 2207 were deemed valid by expert reviewers. GPT-4.0 showed a zero-shot  AUC of 0.857, which aggravated with contextual information. Bio_ClinicalBERT, after training, significantly improved, reaching an AUC of 0.998.

CONCLUSION

Bio_ClinicalBERT effectively validates auto-generated nursing statements, offering a promising solution to enhance and streamline healthcare documentation processes.

Nursing diagnoses and hospital readmission of patients with respiratory diseases: Findings from a case-control study

AIM

The rate of readmission after hospitalisation for respiratory diseases has become a common and challenging clinical problem. Social and functional patient variables could help identify cases at high risk of readmission. The aim was to identify the nursing diagnoses that were associated with readmission after hospitalisation for respiratory disease in Spain.

DESIGN

Case-control study within the cohort of patients admitted for respiratory disease during 2016-19 in a tertiary public hospital in Spain (n = 3781).

METHODS

Cases were patients who were readmitted within the first 30 days of discharge, and their controls were the remaining patients. All nursing diagnoses (n = 130) were collected from the electronic health record. They were then grouped into 29 informative diagnostic categories. Clinical confounder-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using logistic regression models.

RESULTS

The readmission rate was 13.1%. The nursing diagnoses categories 'knowledge deficit' (OR: 1.61; 95%CI: 1.13-2.31), 'impaired skin integrity and risk of ulcer infection' (OR: 1.45; 95%CI: 1.06-1.97) and 'activity intolerance associated with fatigue' (OR: 1.56; 95%CI: 1.21-2.01) were associated with an increased risk of suffering an episode of hospital readmission rate at 30% after hospital discharge, and this was independent of sociodemographic background, care variables and comorbidity.

PATIENT OR PUBLIC CONTRIBUTION

The nursing diagnoses assigned as part of the care plan of patients during hospital admission may be useful for predicting readmissions.

Nursing Diagnosis Accuracy in Nursing Education: Clinical Decision Support System Compared With Paper-Based Documentation-A Before and After Study

Computer-based technologies have been widely used in nursing education, although the best educational modality to improve documentation and nursing diagnostic accuracy using electronic health records is still under investigation. It is important to address this gap and seek an effective way to address increased accuracy around nursing diagnoses identification. Nursing diagnoses are judgments that represent a synthesis of data collected by the nurse and used to guide interventions and to achieve desirable patients' outcomes. This current investigation is aimed at comparing the nursing diagnostic accuracy, satisfaction, and usability of a computerized system versus a traditional paper-based approach. A total of 66 nursing students solved three validated clinical scenarios using the NANDA-International terminologies traditional paper-based approach and then the computer-based Clinical Decision Support System. Study findings indicated a significantly higher nursing diagnostic accuracy ( P < .001) in solving cancer and stroke clinical scenarios, whereas there was no significant difference in acute myocardial infarction scenario. The use of the electronic system increased the number of correct diagnostic indicators ( P < .05); however, the level of students' satisfaction was similar. The usability scores highlighted the need to make the electronic documentation systems more user-friendly.

Exploring the terminological validity of 'chronic pain' nursing diagnosis: A retrospective descriptive study using nursing diaries

AIM

The aim of this study is to generate empirical evidence, drawing from clinical records, with the goal of elevating the level of evidence supporting the nursing diagnosis (ND) of 'chronic pain'.

BACKGROUND

Chronic pain is a prevalent condition that affects all age groups. Patients often feel disbelieved about their pain perception, leading to adverse psychological effects, difficulty accessing healthcare and poor rehabilitation outcomes.

DESIGN

Retrospective descriptive study. Standards for Reporting Diagnostic Accuracy Studies guidelines were followed in this study.

METHODS

Data were extracted from Electronic Health Records (EHR) of patients admitted to the University Hospital of Perugia, Italy, between March 2016 and December 2022. The study sample comprised individuals without a specific medical diagnosis or high-risk population. Out of 1,048,565 EHR, 43,341 clinical-nursing diaries with the keyword 'pain' were identified, from which 283 clinical-nursing notes were selected based on a keyword-based retrieval technique and diagnostic definition for further analysis.

RESULTS

Our study findings support the diagnostic descriptors of the 'chronic pain' ND in clinical-nursing diaries. We observed the presence of 9 out of 11 defining characteristics, 7 out of 10 related factors, 4 out of 8 at-risk populations and 11 out of 17 associated conditions.

CONCLUSIONS

The study validated diagnostic criteria for chronic pain and proposed 'haematological pathology' as a new associated condition. The findings were presented to the Diagnosis Development Committee of NANDA-International for further review. However, limitations of the study prompted the need for further analysis using natural language processing and artificial neural network techniques. As a result, a new research direction using artificial intelligence (AI) tools was initiated.

RELEVANCE TO CLINICAL PRACTICE

The study validates diagnostic descriptors for chronic pain and proposes future directions in semantic analysis and AI tools, aiming to enhance clinical practice and decision-making in nursing care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Removing the roadblocks to promoting health equity: finding the social determinants of health addressed in standardized nursing classifications

Providing 80% of healthcare worldwide, nurses focus on physiologic and psychosocial aspects of health, which incorporate social determinants of health (SDOH). Recognizing their important role in SDOH, nurse informatics scholars included standardized measurable terms that identify and treat issues with SDOH in their classification systems, which have been readily available for over 5 decades. In this Perspective, we assert these currently underutilized nursing classifications would add value to health outcomes and healthcare, and to the goal of decreasing disparities. To illustrate this, we mapped 3 rigorously developed and linked classifications: NANDA International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) called NNN (NANDA-I, NIC, NOC), to 5 Healthy People 2030 SDOH domains/objectives, revealing the comprehensiveness, usefulness, and value of these classifications. We found that all domains/objectives were addressed and NNN terms often mapped to multiple domains/objectives. Since SDOH, corresponding interventions and measurable outcomes are easily found in standardized nursing classifications (SNCs), more incorporation of SNCs into electronic health records should be occurring, and projects addressing SDOHs should integrate SNCs like NNN into their ongoing work.

Future advancement of health care through standardized nursing terminologies: reflections from a Friends of the National Library of Medicine workshop honoring Virginia K. Saba

OBJECTIVE

To honor the legacy of nursing informatics pioneer and visionary, Dr. Virginia Saba, the Friends of the National Library of Medicine convened a group of international experts to reflect on Dr. Saba's contributions to nursing standardized nursing terminologies.

PROCESS

Experts led a day-and-a-half virtual update on nursing's sustained and rigorous efforts to develop and use valid, reliable, and computable standardized nursing terminologies over the past 5 decades. Over the course of the workshop, policymakers, industry leaders, and scholars discussed the successful use of standardized nursing terminologies, the potential for expanded use of these vetted tools to advance healthcare, and future needs and opportunities. In this article, we elaborate on this vision and key recommendations for continued and expanded adoption and use of standardized nursing terminologies across settings and systems with the goal of generating new knowledge that improves health.

CONCLUSION

Much of the promise that the original creators of standardized nursing terminologies envisioned has been achieved. Secondary analysis of clinical data using these terminologies has repeatedly demonstrated the value of nursing and nursing's data. With increased and widespread adoption, these achievements can be replicated across settings and systems.