Nursing Interventions in the Clinical Practice of an Intensive Care Unit

Application of anthropometric methods in the nursing process of nursing research

OBJECTIVES

to identify anthropometric techniques and measurements related to nursing diagnoses and interventions, included in the NANDA International (NANDA-I) and Nursing Interventions Classification (NIC), respectively.

METHODS

descriptive study of the revision of the NANDA-I and NIC taxonomies by professors of Nursing of the Universidad Complutense de Madrid.

RESULTS

A total of 24 nursing diagnoses, 20 nursing interventions and 71 nursing activities were identified that require the use of anthropometric measurements.

CONCLUSIONS

anthropometric measurements are necessary in the conduct of numerous nursing diagnoses and nursing interventions that are commonly used in healthcare practice. It would be useful to systematize the use of anthropometric techniques in the application of the nursing process and to standardize this training process.

Cross mapping between clinical indicators for assistance in intensive care and nursing interventions

OBJECTIVE

Identify the main clinical indicators for assistance in the Intensive Care Unit (ICU) and map them in the nursing interventions described by the Nursing Interventions Classification (NIC).

METHODS

Integrative literature review study, followed by cross-mapping between clinical indicators for assistance in the ICU care and NIC nursing interventions and activities.

RESULTS

36 articles were identified, which resulted in 285 clinical indicators for ICU care, with mechanical ventilatory assistance, pain, sedation, psychomotor agitation, delirium, anxiety, altered heart rate, diet by naso tube / oroenteral and diarrhea the clinical indicators for assistance in the ICU the most prevalent. These were mapped in 12 Nursing Interventions Classification interventions and 130 nursing activities.

FINAL CONSIDERATIONS

It is concluded that the clinical indicators for ICU care associated with Nursing Interventions Classification are concrete data that assist intensive care nurses in their clinical practice.

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

RESUMO Objetivo: identificar diagnósticos de enfermagem em pacientes hospitalizados em UTI por meio do mapeamento cruzado de termos contidos nas anotações de enfermagem, com a Taxonomia da NANDA-I. Método: estudo exploratório descritivo, mediante análise retrospectiva dos registros de enfermagem em 256 prontuários de pacientes que estiveram hospitalizados na UTI geral de um hospital da fronteira oeste do Rio Grande do Sul. Extraíram-se, dos registros, termos que indicavam condições que demandavam intervenções de enfermagem, realizou-se mapeamento cruzado dos mesmos com os diagnósticos da Taxonomia da NANDA-I e confirmação em grupo focal de enfermeiros. Analisaram-se os dados utilizando-se estatística descritiva. Resultados: identificaram-se 832 termos e expressões que se referiam a 52 diferentes diagnósticos em nove dos 13 domínios da Taxonomia da NANDA-I. Conclusão: este estudo permitiu identificar diagnósticos de enfermagem presentes em pacientes hospitalizados na UTI, trazendo implicações para gestão do cuidado, processo de formação de especialistas na área e sistemas de informação.

Critical care nursing interventions and the time required for their completion in Intensive Care Units: A Delphi study

OBJECTIVE

To determine which interventions within the Nursing Interventions Classification are most often applied in intensive care units and to validate the time required for each.

METHODOLOGY

A three-stage e-Delphi was conducted; 21 panelists were recruited, seven manager nurses and 14 clinical nurses with higher degrees and more than five years experience in intensive care nursing. The first round explored the most common interventions applied. Additionally, panelists were asked to propose others. In the second round, participants reflected on the interventions where no consensus was reached as well as to estimate the time required for each intervention. In the third, panelists were queried about the time required for the interventions for which consensus regarding the time was not reached.

RESULTS

A total of 183 interventions were included; 50% of the "Physiological: Complex" domain. The list included 52 (90%) of the 58 "core interventions for critical care nursing" identified in the Nursing Interventions Classification. The time required for 89.1% of the interventions was the same as in the Nursing Interventions Classification seminal work recommendations.

CONCLUSION

Results provide a clear picture of nursing activity in general intensive care units, allows to tailor the Nursing Intervetions Classification in Catalonia context and to confirm findings of previous studies.

CEI-UCI: instrumento para evaluar el cuidado de enfermería individualizado de adultos en la UCI

<p>El propósito de este estudio fue diseñar el instrumento Cuidado de Enfermería Individualizado en Unidad de Cuidado Intensivo (CEI-UCI) para identificar las intervenciones de cuidado de enfermería individualizado en pacientes con ventilación mecánica invasiva en la UCI.</p><p><strong>Metodología:</strong> Estudio psicométrico, exploratorio-observacional, con <em>n</em> = 156 enfermeras que laboraban en la UCI con pacientes adultos en ventilación mecánica. Se diseñaron un total de 85 ítems para iniciar las pruebas. Para la validez facial se utilizó la V. Aiken por encima de 0,70. Para la validez de contenido se realizó el cálculo de Lawshe Modificado igual o mayor a de 0,58. La validez de constructo se obtuvo por medio del análisis factorial con ocho dominios nanda. La confiabilidad se reportó con test-retest para los días 1, 2 y 3 de estadía de los pacientes en UCI.</p><p><strong>Resultados:</strong> El CEI-UCI presentó una validez facial con rangos entre 0,75-0,82, con un CVI con rangos entre 0,58-0,90. La validez de constructo se confirmó con una varianza total explicada del 73% para cuatro factores. La confiabilidad por el test-retest entre los tres primeros días de aplicado el instrumento se presentó con un rango de 0,662 a 1,00.</p><p><strong>Conclusiones:</strong> El instrumento CEI-UCI posee 53 ítems y seis dimensiones con validez facial, aparente y consistencia interna. La validez de constructo derivada del análisis factorial<br />de cuatro factores se denominaron Dimensiones, a saber: F1, <em>Protección y seguridad</em> (17 ítems); F2, <em>Interacción fisiológica y social</em> (3 ítems); F3, <em>Roles y conexiones sociales</em> (13 ítems); y F4, <em>Autopercepción y nutrición</em> (11 ítems). Además, hubo dos dimensiones permanentes y centinelas: <em>Perceptual-Cognitivo</em> y el de <em>Confort</em>.</p>

[NIC as a tool for assessing competences of nursing students in clinical placement at surgical units]

BACKGROUND

This paper shows the utility of a NIC standardized language to assess the extent of nursing student skills at Practicum in surgical units

OBJECTIVE

To identify the nursing interventions classification (NIC) that students can learn to perform in surgical units. To determine the level of difficulty in learning interventions, depending on which week of rotation in clinical placement the student is.

METHOD

Qualitative study using Delphi consensus technique, involving nurses with teaching experience who work in hospital surgical units, where students undertake the Practicum. The results were triangulated through a questionnaire to tutors about the degree of conformity.

RESULTS

A consensus was reached about the interventions that students can achieve in surgical units and the frequency in which they can be performed. The level of difficulty of each intervention, and the amount of weeks of practice that students need to reach the expected level of competence was also determined.

CONCLUSION

The results should enable us to design better rotations matched to student needs. Knowing the frequency of each intervention that is performed in each unit determines the chances of learning it, as well as the indicators for its assessment.

Assessment of nursing care using indicators generated by software

OBJECTIVE

to analyze the efficacy of the Nursing Process in an Intensive Care Unit using indicators generated by software.

METHOD

cross-sectional study using data collected for four months. RNs and students daily registered patients, took history (at admission), performed physical assessments, and established nursing diagnoses, nursing plans/prescriptions, and assessed care delivered to 17 patients using software. Indicators concerning the incidence and prevalence of nursing diagnoses, rate of effectiveness, risk diagnoses, and rate of effective prevention of complications were computed.

RESULTS

the Risk for imbalanced body temperature was the most frequent diagnosis (23.53%), while the least frequent was Risk for constipation (0%). The Risk for Impaired skin integrity was prevalent in 100% of the patients, while Risk for acute confusion was the least prevalent (11.76%). Risk for constipation and Risk for impaired skin integrity obtained a rate of risk diagnostic effectiveness of 100%. The rate of effective prevention of acute confusion and falls was 100%.

CONCLUSION

the efficacy of the Nursing Process using indicators was analyzed because these indicators reveal how nurses have identified patients' risks and conditions, and planned care in a systematized manner.

The immediate post-operative period following lung transplantation: mapping of nursing interventions

OBJECTIVES:

to investigate the principle nursing interventions/actions, prescribed in the immediate post-operative period for patients who receive lung transplantation, recorded in the medical records, and to map these using the Nursing Interventions Classification (NIC) taxonomy.

METHOD:

retrospective documental research using 183 medical records of patients who received lung transplantation (2007/2012). The data of the patients' profile were grouped in accordance with the variables investigated, and submitted to descriptive analysis. The nursing interventions prescribed were analyzed using the method of cross-mapping with the related interventions in the NIC. Medical records which did not contain nursing prescriptions were excluded.

RESULTS:

the majority of the patients were male, with medical diagnoses of pulmonary fibrosis, and underwent lung transplantation from a deceased donor. A total of 26 most frequently-cited interventions/actions were found. The majority (91.6%) were in the complex and basic physiological domains of the NIC. It was not possible to map two actions prescribed by the nurses.

CONCLUSIONS:

it was identified that the main prescriptions contained general care for the postoperative period of major surgery, rather than prescriptions individualized to the patient in the postoperative period following lung transplantation. Care measures related to pain were underestimated in the prescriptions. The mapping with the taxonomy can contribute to the elaboration of the care plan and to the use of computerized systems in this complex mode of therapy.

Transcultural mapping and usability testing of the clinical care classification system for an Iranian neonatal ICU population

The aim of this research study was to map nursing diagnoses and interventions documented and observed in a neonatal ICU to the Clinical Care Classification system and to validate the translation of these mapped diagnoses and interventions into Persian. This descriptive research used directed content analysis to map diagnoses and interventions to the Clinical Care Classification. Documentation reports of nursing care were extracted from a paper-based documentation system for infants hospitalized in April, May, and June 2011. Observations of care were conducted and compared with documentation to itemize any interventions not included in the documented record. Documented reports of nurses' care and recorded observations were analyzed through directed content analysis, and obtained expressions were mapped to the diagnoses and intervention coding system of the Clinical Care Classification and translated into Persian. Validation of the subsequent code translation was obtained from nursing experts using the Delphi method in two rounds. Findings showed the most frequent nursing diagnoses were related to respiratory condition of infants such as mechanical ventilation dependency (21.1%), and the most frequent nursing interventions were related to completing physician orders such as blood sampling and medication administration (23.9%). Only 47.8% of Clinical Care Classification diagnoses and interventions codes were reflected in the data set. The relatively low rate of nursing care documented in therecords could be due to both the lack of a nursingcare delivery framework, such as the nursing process, and the lack of any framework or standardization in the documentation system in this setting. Using a framework for care delivery and a coding system for documentation of care such as the ClinicalCare Classification would allow for the more complete documentation of nursing care and subsequently the ability to track and analyze this care.

Basic nursing care: retrospective evaluation of communication and psychosocial interventions documented by nurses in the acute care setting

PURPOSE

This study aimed to evaluate the frequency of psychosocial aspects of basic nursing care, as e-charted by nurses, when using an interface terminology.

METHODS

An observational, multicentre study was conducted in acute wards. The main outcome measure was the frequency of use of the psychosocial interventions in the electronic nursing care plans, analysed over a 12 month retrospective review.

FINDINGS

Overall, 150,494 electronic care plans were studied. Most of the intervention concepts from the interface terminology were used by registered nurses to illustrate the psychosocial aspects of fundamentals of care in the electronic care plans.

CONCLUSIONS AND IMPLICATIONS

The results presented help to demonstrate that the interventions of this interface terminology may be useful to inform psychosocial aspects of basic and advanced nursing care.

CLINICAL RELEVANCE

The identification of psychosocial elements of basic nursing care in the nursing documentation may lead to obtain a deeper understanding of those caring interventions nurses consider essential to represent nurse-patient interactions. The frequency of psychosocial interventions may contribute to delineate basic and advanced nursing care.