Nursing diagnoses in intensive care: cross-mapping and NANDA-I taxonomy

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.

Accuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients

OBJECTIVES

to analyze the accuracy of the clinical indicators of ineffective airway clearance in adult intensive care unit patients.

METHODS

diagnostic accuracy study, performed in the intensive care unit of a university hospital in northeastern Brazil. The sample consisted of 104 patients hospitalized between June and October 2019.

RESULTS

the prevalence of ineffective airway clearance was 36.54%. The indicators with high specificity included absence of cough (0.8326), orthopnea (0.6817), adventitious breath sounds (0.8175), and diminished breath sounds (0.8326). The clinical indicators with high sensitivity and specificity were alteration in respiratory rate (0.9999) and alteration in respiratory pattern (0.9999).

CONCLUSIONS

six clinical indicators provided an accurate identification of ineffective airway clearance. The clinical indicators alteration in respiratory rate and alteration in respiratory pattern were the most accurate for critical adult patients. The findings of this study contribute to accurate diagnostic inferences and to prevention of respiratory complications in these patients.

[Complexity of outpatient intensive care for ventilated people: Cross-mapping into the standardised NNN-taxonomy]

Complexity of outpatient intensive care for ventilated people: Cross-mapping into the standardised NNN-taxonomy Abstract. Background: In Germany, free text is the preferred method for recording the nursing process in outpatient intensive care, although classification systems could enable a more precise description. Research question: How is nursing care for people with outpatient ventilation represented by the NNN-taxonomy and what are the recommendations for nursing practice? Methods: A qualitative "multiple case" design was applied. Using deductive content analysis (data sources: nursing documentation and secondary analysis of interviews with affected persons), several cases, both individually and across all cases were linked to the NNN-taxonomy (cross-mapping). Results: In total, the nursing documentation of 16 invasively ventilated persons with a mean age of 58.4 years (SD = 16.3) was analysed. Seven persons additionally contributed interview data. Documentation was mainly based on the "Strukturmodell" (14/16) with a moderate to high accuracy (D-Catch Score: 16.6; SD = 4.1). Cross-mapping resulted in 4016 codes: 618 nursing diagnoses, 1956 interventions and 1442 outcomes. Documentation was strongly measure-oriented, not very person-centred and with a lack of differentiation between diagnosis and intervention. Conclusions: To improve nursing practice, a person-centred attitude and the ability to differentiate between nursing diagnoses, interventions and outcomes should be promoted.

NANDA International nursing diagnoses in the coping/stress tolerance domain and their linkages to Nursing Outcomes Classification outcomes and Nursing Interventions Classification interventions in the pre-hospital emergency care

Aim

To determine the prevalence of NANDA International nursing diagnoses in the coping/stress tolerance domain and their linkages to Nursing Outcomes Classification outcomes and Nursing Interventions Classification interventions in the pre‐hospital emergency care setting.

Design

Retrospective descriptive study of electronic record review.

Methods

Eight thousand three hundred three episodes recorded during the year 2019 were recovered from the electronic health records of a public emergency care agency. The prevalence of NANDA International nursing diagnosis, Nursing Outcomes Classification outcomes and Nursing Interventions Classification interventions was determined. A cross‐tabulation analysis was performed to determine the linkages. Data were accessed in November 2020.

Results

NANDA International nursing diagnoses Anxiety (00146) and Fear (00148) represented more than 90% of the diagnoses recorded in the domain. Anxiety level (1211) and emotional support (5270) were the most recorded Nursing Outcomes Classification outcomes and Nursing Interventions Classification interventions, with almost 20% and 5% of total records, respectively. The linkage between nursing diagnosis Anxiety (00146), outcome Anxiety level (1211) and intervention Anxiety reduction (5820) was the most recorded with slightly more than 3% of the total.

Conclusion

Eight different NANDA International nursing diagnoses in the coping/stress tolerance domain were recorded. Nursing Outcomes Classification outcomes were selected aimed mainly at psychological well‐being and Nursing Interventions Classification interventions to support coping. In general, linkages were aimed to provide emotional support, physical well‐being, information, education and safety.

Impact

This study showed that pre‐hospital emergency care nurses diagnose and treat human responses in the coping/stress tolerance domain. Expert consensus‐based linkages may be complemented by the results of this study, increasing the levels of evidence of both individualized and standardized care plans for critical patients assisted by pre‐hospital emergency care nurses.

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.

Ants (Hymenoptera: Formicidae) as Potential Mechanical Vectors of Pathogenic Bacteria in a Public Hospital in the Eastern Amazon, Brazil

Studies related to ants found in hospital environments have aroused interest in their role as mechanical vectors of pathogenic microorganisms. The objective of the current research was to determine the species composition and bacterial contamination of ant species found in a public hospital in the eastern Amazonian region. Ants were captured using bait containing honey and sterilized sardines in 15 locations within the Macapá Emergency Hospital, Amapá. Ants were identified morphologically using specific keys. Bacteria were first inoculed in a Brain Heart Infusion broth and then plated on 5% Agar with blood or MacConkey media. Bacterial species were identified through biochemical procedures. In total, 9,687 ants were collected, with 69.8% from the dry season and 30.2% from the rainy season. Nine species of ants were identified belonging to three subfamilies: the Monomorium pharaonis (Linnaeus 1758) being the most common, comprising 39.2% of the total specimens. Only one ant species was found in each bait, facilitating microbiological analyses. In total, 92 bacteria isolates were identified comprising 12 species. Pseudomonas aeruginosa Schroeter 1872 (Pseudomonadales: Pseudomonadaceae) was pathogenic bacteria, most frequently isolated, comprising 10.9% of the positive samples. The most contaminated ant in the study was M. pharaonis with 38.3%. It was the dominant ant species in this hospital environment. Its wide prevalence, forage day and night of this vector in hospital facilitated bacterial contamination. The presence of bacteria on ants may be associated with the dissemination of pathogens which cause hospital infections, making pest control a necessity in these institutions.

Braden Scale in pressure ulcer risk assessment

OBJECTIVE

To analyze the applicability of the Braden Scale to individuals admitted to an Intensive Care Unit (ICU) with the nursing diagnosis Impaired Physical Mobility, in its prediction potential to develop pressure ulcer (PU).

METHODS

A cross-sectional, quantitative study that evaluated all patients hospitalized in an ICU between November 2016 and February 2017, with the Braden Scale.

RESULTS

The prevalence of PU was 35.8% (24/67), in male individuals 58.3% (14/24), diagnosed with ischemic CVA 51.9% (12/27), and with hemorrhagic CVA 7.4% (2/27). Among patients classified at severe risk of developing pressure ulcer, 83.3% (20/53) developed it, and 76.7% (33/53) did not develop it.

CONCLUSION

The performance of the Braden Scale showed a balance between sensitivity and specificity, confirming it as a better predictive risk assessment instrument in this group of patients.

Protocol of nursing care in hospitalized dysphagic patients

PURPOSE

To investigate nursing care for patients hospitalized with oropharyngeal dysphagia.

METHOD

This is a descriptive study of a qualitative approach, developed during the year 2017, in a Public hospital in Rio de Janeiro that offers a nursing residency program. The sample consisted of 17 nursing residents who work in the care of dysphagic patients. Data collection was realized by applying the problem-based learning methodology and data were analyzed according to the content analysis technique.

RESULTS

The data analysis allowed for the identification of the main aspects of nursing care in the patient hospitalized with oropharyngeal dysphagia and the elaboration of a nursing care protocol for the patient, based on a discussion of thematic categories.

CONCLUSION

This study allowed for the identification of the relevant nursing care for the patient hospitalized with oropharyngeal dysphagia, which could provide assistance for nurses, thereby improving the quality of care and safety of the service provided for hospitalized patients.

Validation and applicability of instrument for documenting the nursing process in intensive care

OBJECTIVE

to validate the content of an instrument for documenting the steps of the Nursing Process, using the standardized languages NANDA-I, NOC, and NIC (NNN), aiming at hospitalized patients in an Intensive Care Unit (ICU).

METHOD

A methodological research performed in three steps: design of the existing instrument from the systems NANDA-I, NOC and NIC; content validation by 13 judges, from a four-point Likert-type scale - items were evaluated as to their clarity and pertinence; applicability: judgement of the content regarding clarity, reading ease, and presentation for 40 critical-care nurses. The Content Validity Index (CVI) and the Kappa coefficient (k) was calculated to measure the proportion of relevance and clarity, was well as to verify the level of agreement between the experts in each item.

RESULTS

The instrument was considered clear and pertinent, with CVI above 0.8 in most items and overall Concordance Index (CI) of 0.90, showing a satisfactory level of agreement between judges. Regarding applicability, the instrument was deliberated clear, of easy reading, and with proper presentation by most critical-care nurses, being validated through 11 diagnoses with their respective results and nursing interventions.

CONCLUSION

The instrument showed to be valid and applicable for the group studied. It is expected that this study is able to contribute to the improvement of the Nursing Process in intensive care.

Nursing diagnoses in the hemodynamics sector: an adaptive perspective

OBJECTIVE

To identify nursing diagnoses of NANDA-I Taxonomy II in patients treated in the Hemodynamics Sector.

METHOD

A descriptive, cross-sectional study with a quantitative approach conducted in a teaching hospital in the interior of Rio Grande do Sul. Data were collected through a sociodemographic characterization instrument and information regarding the problems of physical-physiological adaptation.

RESULTS

100 patients participated in the study. Defining characteristics, risk factors and related factors were identified through adaptation problems. In all, 28 nursing diagnoses were identified, and 13 were considered for the discussion which presented frequency above 50% and represented the main adaptive problems. Protection, neurological and activity and rest components were the most frequent.

CONCLUSION

The recognition of nursing diagnoses facilitates a connection between the main problems of adaptation and nursing interventions.

Clinical Predictors of Risk for Decreased Cardiac Tissue Perfusion After Percutaneous Coronary Intervention: A Retrospective Cohort Study

OBJECTIVE

To establish clinical predictors of risk for decreased cardiac tissue perfusion (DCTP) after percutaneous coronary intervention (PCI).

METHODS

Data on demographic, anthropometric, clinical, and procedural variables were collected as explanatory from a database of 1,542 adult patients undergoing PCI. A diagnosis of periprocedural myocardial infarction was used to confirm DCTP. A multivariate logistic regression determined the predictors of DCTP.

RESULTS

The independent predictors of risk for DCTP were age (OR = 1.02, CI 95% = 1.01-1.03, p = .008), multivessel disease (OR = 1.79, CI 95% = 1.30-2.46, p <.001) and intraprocedural lesion complications (OR = 4.56, CI 95% = 3.03-6.87, p <.001).

CONCLUSION AND IMPLICATIONS FOR NURSING PRACTICE

These results increase the level of evidence of risk for DCTP by refining its risk factors and can support nurses' clinical judgment.

Diagnostic labels of NANDA-I in a southern region of Spain

Objective

to determine the incidence of NANDA-I diagnostic labels (North American Nursing Diagnosis Association-International) and to establish the distribution of cases of assistance and the associated labels, according to sociodemographic variables (age and sex).

Method

descriptive, cross-sectional epidemiological study of labels of NANDA-I, under ecological design. The distribution of labels was analyzed according to sex and age; the corresponding frequencies were calculated and for each label the incidence were calculated rates with aggregate data from the attended cases.

Results

the total number of cases of care under study was 9,928 (41.65% men and 58.35% women). The identified labels were 16,456 (7,084 men and 9,372 women); average of 1.7 labels per case of care; Out of 216 labels proposed by NANDA-I, in its 2012-14 classification, 152 were used, representing 70.4%. The labels with the highest incidence rates per thousand inhabitants were: Anxiety, Willingness to Improve Knowledge and Risk of Infection.

Conclusions

the study allowed detecting, through NANDA-I, the answers to the health problems of greater incidence in the users attended.