Acurácia na inferência de diagnósticos de enfermagem de pacientes com insuficiência cardíaca

Development and psychometric testing of a competency of nursing process questionnaire

Objectives

This study aimed to develop and evaluate a competency of nursing process questionnaire (CNPQ) for registered nurses in Cambodia.

Methods

Guided by the nursing process, an initial questionnaire was generated through focus group discussion, literature review, and the expert consultation. Finally, the validity and reliability of the questionnaire were validated through a questionnaire survey online of 260 registered nurses selected from Complimentary Package Activities 1, 2, 3, and national hospitals from January to February 2022 in five geographic areas of Cambodia.

Results

The content validity index was 1.00. The Cronbach's α coefficient for the whole questionnaire was 0.963, and the range for the five dimensions was 0.963-0.964, which shows that the questions were consistent. The test-retest reliability was 0.769. The exploratory factor analysis led to a list of 24 items that were grouped into five dimensions: assessment, diagnosis, planning, implementation, and evaluation. The cumulative variance contribution rate was 70.08%.

Conclusions

The CNPQ developed in this study showed good reliability and validity and can be used to assess the competency of registered nurses by themselves and help nursing managers to develop the relevant policies.

Accuracy of clinical indicators of the nursing diagnosis of dysfunctional gastrointestinal motility in infants

This study aimed to analyze the accuracy of the clinical indicators of the nursing diagnosis of dysfunctional gastrointestinal motility in infants from neonatal units and identify their association with clinical variables. This is a study of the diagnostic accuracy of clinical indicators of the diagnosis of dysfunctional gastrointestinal motility, with a cross-sectional design, performed on 228 hospitalized infants in neonatal units. A high prevalence of dysfunctional gastrointestinal motility was identified in the studied population. Regarding accuracy measures, clinical indicators such as increased gastric residual, changes in bowel sounds, bile-colored gastric residual, regurgitation, absence of flatus, and hard and formed stool were useful to discriminate between infants with and without dysfunctional gastrointestinal motility. The findings can help nurses during the diagnostic process, as they identify which defining characteristics can be used to confirm or rule out the probability of occurrence of the diagnosis.

Acurácia dos diagnósticos de Enfermagem nos cuidados ao paciente crítico

Objetivo: avaliar a acurácia dos diagnósticos de Enfermagem de pacientes internados em uma Unidade de Terapia Intensiva. Método: pesquisa quantitativa, documental, retrospectiva e transversal. Foram avaliados 122 prontuários de pacientes adultos internados na Unidade de Terapia Intensiva de um hospital público catarinense, no período de 12 meses, que continham o histórico de Enfermagem e os diagnósticos de Enfermagem documentados nas primeiras 24 horas de internação do paciente. A avaliação da acurácia dos diagnósticos de Enfermagem foi realizada por duas avaliadoras utilizando a Escala de Acurácia dos Diagnósticos de Enfermagem - versão 2. Resultados: foram avaliados 809 diagnósticos, contidos em 122 prontuários, documentados por nove enfermeiros. Houve predominância de diagnósticos de Enfermagem com alta acurácia (n=665; 82,2%). Diagnósticos com acurácia moderada (n=64; 7,9%), acurácia baixa (n=54; 6,6%) e acurácia nula (n=26; 3,2%) foram pouco frequentes. Conclusão: o alto grau de acurácia da maioria significativa dos diagnósticos de Enfermagem avaliados indica o nível de refinamento do raciocínio clínico diagnóstico dos enfermeiros.

Prepartum, childbirth, and immediate puerperium: Nursing diagnoses of mothers of extremely preterm infants

BACKGROUND

Maternal mortality remains high, despite all the advances and efforts that have occurred in recent years and is directly related to the quality of care provided during pregnancy, childbirth, and in the puerperium.

PURPOSE

Identify the possible nursing diagnoses of mothers of newborns admitted to neonatal intensive care in the prepartum period, childbirth, and the puerperium.

METHODS

Observational, cross-sectional study carried out by analyzing the medical records of mothers of newborns who required hospitalization in neonatal intensive care and determining the diagnoses through a process of diagnostic inference, based on NANDA-I Taxonomy, during the period from 2007 to 2016.

FINDINGS

After reviewing the medical records of 272 mothers, a total of 3,843 observations were identified, distributed in 42 diagnoses, with Excessive fluid volume presenting the greatest predictive power over the outcome variable. The second group of more predictive variables comprised the Risk of vascular trauma, Risk of infection, Impaired parenthood, and Risk of body temperature imbalance. The third group, in turn, consisted of the following diagnoses: Insomnia, Pain during labor, Risk of impaired bonding, Acute pain, and Ineffective Breastfeeding.

CONCLUSIONS

The present study enabled the identification of the most frequent NANDA-I nursing diagnoses occurring during the prepartum period, childbirth, and the immediate puerperium of mothers of newborns admitted to neonatal intensive care, as well as those of greatest importance. Based on the encountered diagnoses, it can be concluded that future studies should be carried out in order for validation.

IMPLICATIONS

The knowledge of these diagnoses can contribute to the instrumentalization of nursing professionals, with consequent improvements in the nursing process and the provided assistance, aiming to assist in the reduction of maternal morbidity and mortality.

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.

Relationships between the Advanced Nursing Process quality and nurses' and patient' characteristics: A cross-sectional study

Aim

This study aimed to assess (a) nurses' knowledge and their attitude towards the Advanced Nursing Process-nursing assessment, diagnoses, interventions, outcomes, (b) the quality of the Advanced Nursing Process and (c) relationships with patient characteristics.

Design

A cross-sectional, descriptive correlational study was performed.

Methods

Ninety-two registered nurses and ninety nursing records of six hospital wards were included. In January 2016, a knowledge test, a self-assessment tool for measuring nurses' attitude (PND) and the Quality of Diagnoses, Interventions and Outcomes Revised instrument (Q-DIO R) were applied. The correlations between nurses' knowledge, attitude, patient characteristics, organizational factors and the Advanced Nursing Process quality were investigated.

Results

Nurses demonstrated low levels of knowledge, positive attitudes and an average Advanced Nursing Process quality. Accurate nursing diagnoses were strong and highly significantly related to effective nursing interventions and better nursing-sensitive patient outcomes. A higher proportion of registered nurses was related to better nursing outcomes.

Accuracy of Defining Characteristics for Nursing Diagnoses Related to Patients with Respiratory Deterioration

PURPOSE

To evaluate accuracy of defining characteristics (DCs) for impaired gas exchange (IGE), impaired spontaneous ventilation (ISV), and ineffective breathing pattern (IBP) in respiratory deterioration.

METHODS

This study is a retrospective analysis of medical records. The accuracy and predictive ability of DC or of clusters are calculated.

FINDINGS

In this study, 391 records were evaluated. For IGE, DCs or clusters with higher efficiency were "hypercapnia" (78%), "somnolence" (74.4%), and "hypercapnia + tachycardia" (88%); for ISV, the cluster with higher efficiency was "increased heart rate ± decrease in cooperation" (70.1%); and for IBP, no DC or cluster exceeded 70% efficiency. These were confirmed by logistic regression.

CONCLUSION

Few DCs had adequate efficiency for respiratory nursing diagnoses, while in some cases clusters accounted for higher efficiency.

IMPLICATIONS FOR NURSING PRACTICE

Clusters of DC may be relevant for respiratory diagnoses.

Clinical validation of nursing diagnosis "00085 Impaired Physical Mobility" in multiple traumas victims

OBJECTIVE

to clinically validate the nursing diagnosis "Impaired Physical Mobility", identifying its prevalence, defining characteristics, related factors, and associated conditions with the calculation of accuracy measures and generation of Decision Trees, as well as clinically and etiologically characterize the multiple traumas victims.

METHOD

methodological, cross-sectional study of clinical validation type, using diagnostic accuracy measures and generating decision tree.

RESULTS

the sample consisted of 126 patients, 73% male, with a mean age of 38.29 years. The frequency of the nursing diagnosis studied was 88.10%; the defining characteristic with the highest prevalence was "Difficulty turning" (58.73%), with a predictive power of 98.6%; the associated condition "Alteration in bone structure integrity" stood out with 72.22%. The accuracy measures also indicated their predictive power.

CONCLUSION

the components aforementioned were considered predictors of this diagnosis. This study contributed to improve the identification of clinical indicators associated with advanced methods of diagnostic validation, directing care and reducing the variability present in clinical situations.

Measuring the effects of guided clinical reasoning on the Advanced Nursing Process quality, on nurses' knowledge and attitude: Study protocol

AIM

This article is a report of a study protocol designed to examine the effects of guided clinical reasoning on the quality of the Advanced Nursing Process-the evidence-based version of the traditional nursing process. It aims to describe the theoretical framework-Kirkpatrick's evaluation model, the key concepts and the instruments for the planned study.

DESIGN

A complex experimental intervention study using data and method triangulation is proposed.

METHODS

Registered Nurses (N = 92), nursing records (N = 180) and 24 patients will be included. Nurses' knowledge and attitude will be evaluated by questionnaires/tests, their clinical performance by observations. Patients' perspective will be addressed by qualitative interviews and patient records by using the instrument Quality of Diagnoses, Interventions and Outcomes revised (Q-DIO R).

DISCUSSION

Kirkpatrick's model (including quantitative and qualitative methods) is providing evaluations from different perspectives on the quality of the Advanced Nursing Process and on intervention effects.

Nursing Diagnosis of Neonatal Jaundice: Study of Clinical Indicators

PURPOSE

This study aimed to identify the defining characteristics of, and examine their association with, the nursing diagnosis (ND) of Neonatal Jaundice (00194) in sample of hospitalized newborns.

DESIGN AND METHODS

A cross-sectional study developed with 100 newborns aged between 24h and ten days. Data collection was performed in a public hospital of tertiary health care between March and June of 2016.

RESULTS

The ND of Neonatal jaundice was present in 31% of the sample. The most frequent defining characteristics were yellow-orange skin color (65%) and abnormal blood profile (75%). Yellow mucous membranes, yellow-orange skin color and bruised skin showed statistically significant sensitivity and specificity. Yellow mucous membranes, yellow sclera and yellow-orange skin color were statistically associated with Neonatal jaundice. Yellow mucous membranes showed the best diagnostic accuracy measurements.

CONCLUSIONS

The clinical indicators that best predicted and increased the probability of developing jaundice were identified.

PRACTICE IMPLICATIONS

These clinical indicators increase the ability of nurses to clinically infer nursing diagnoses. This allows nurses to identify signs and symptoms of health conditions in a sensible and definitive manner, decreasing the possibility of errors.