A retrospective descriptive study of NANDA-I nursing diagnoses used by midwives working in obstetrics and gynecologic service: An example from south-eastern Turkey

PURPOSE

This study aims to identify NANDA-I nursing diagnoses that midwives working in obstetrics and gynecologic service use while managing the electronic nursing care process.

METHODS

This retrospective study was conducted in a descriptive way to evaluate electronic care plan records of 3025 patients staying in obstetrics and gynecologic service between April 1, 2020. and April 1, 2021. Diagnoses in the records of the electronic care process were digitalized by two faculty members. Then, NANDA-I nursing diagnoses used by midwives were identified. NANDA-I nursing diagnoses used by midwives were identified.

FINDINGS

It was determined that diagnoses in care plans documented from the system within the 1-year period fell into eight domains and 10 classes, and 5819 diagnoses were given in total. The most frequent diagnoses given in obstetrics and gynecologic service were "acute pain" and "risk for bleeding."

CONCLUSION

Findings of this study revealed that nursing care records in obstetrics and gynecologic service did not have a large number of diagnoses and interventions.

IMPLICATIONS FOR NURSING PRACTICE

Care plans directly reflect the contribution of the care to the patient. Consequently, midwives being aware of and recording nursing diagnoses while giving care will ensure a standardized language and visibility in care. More coverage of midwifery-related diagnoses in the midwifery curriculum will make NANDA-I nursing diagnoses more visible in midwifery as well.

Standardizing nursing data extracted from electronic health records for integration into a statewide clinical data research network

BACKGROUND

Care plans documented by nurses in electronic health records (EHR) are a rich source of data to generate knowledge and measure the impact of nursing care. Unfortunately, there is a lack of integration of these data in clinical data research networks (CDRN) data trusts, due in large part to nursing care being documented with local vocabulary, resulting in non-standardized data. The absence of high-quality nursing care plan data in data trusts limits the investigation of interdisciplinary care aimed at improving patient outcomes.

OBJECTIVE

To map local nursing care plan terms for patients' problems and goals in the EHR of one large health system to the standardized nursing terminologies (SNTs), NANDA International (NANDA-I), and Nursing Outcomes Classification (NOC).

METHODS

We extracted local problems and goals used by nurses to document care plans from two hospitals. After removing duplicates, the terms were independently mapped to NANDA-I and NOC by five mappers. Four nurses who regularly use the local vocabulary validated the mapping.

RESULTS

83% of local problem terms were mapped to NANDA-I labels and 93% of local goal terms were mapped to NOC labels. The nurses agreed with 95% of the mapping. Local terms not mapped to labels were mapped to the domains or classes of the respective terminologies.

CONCLUSION

Mapping local vocabularies used by nurses in EHRs to SNTs is a foundational step to making interoperable nursing data available for research and other secondary purposes in large data trusts. This study is the first phase of a larger project building, for the first time, a pipeline to standardize, harmonize, and integrate nursing care plan data from multiple Florida hospitals into the statewide CDRN OneFlorida+ Clinical Research Network data trust.

Clinical validation of the terminological subset for people with chronic kidney disease undergoing conservative treatment

OBJECTIVE

To clinically validate a terminological subset of the International Classification for Nursing Practice (ICNP®) to care for people with chronic kidney disease undergoing conservative treatment.

METHOD

Prospective study of clinical validation assessment of 117 nursing diagnoses/outcomes statements and 199 nursing intervention statements. It was operationalized through the following steps: implementation of the Nursing Process in an outpatient clinic in Southeast Brazil; preparation of case studies; analysis of agreement between specialist nurses. The Kappa. Kruskal-Wallis coefficient of agreement and intraclass correlation coefficient (ICC) were used.

RESULTS

The sample consisted of 50 people with chronic kidney disease. Diagnoses/outcomes and interventions were evaluated with almost perfect/perfect agreement and excellent ICC. The Kruskal-Wallis test showed that there was no significant difference between the assessments. The study allowed the clinical validation of a subset with 110 nursing diagnoses/outcomes and 195 nursing interventions.

CONCLUSION

Care for people with chronic kidney disease undergoing conservative treatment based on the proposed subset has become applicable to clinical practice.

ICNP® terminological subset for preventing falls in the elderly in primary care

OBJECTIVE

Build and validate a terminological subset of ICNP® for the prevention of falls in the elderly in the context of primary health care, in light of the Self-Care Deficit Theory.

METHOD

Methodological study developed in accordance with ICN recommendations and the Brazilian method for constructing terminological subsets, in two stages: 1) construction of ICNP® statements of nursing diagnoses, outcomes, and interventions; 2) content validation of statements by specialist nurses.

RESULTS

A total of 182 diagnoses/outcomes and 321 nursing interventions were constructed, which were subjected to content validation by 28 experts, being validated with a Content Validity Index ≥ 0.80. After validation, the statements were organized according to self-care requirements and the majority of diagnoses/outcomes (51.6%) and interventions (52.7%) were classified under health deviation requirements.

CONCLUSION

It was possible to construct and validate a terminological subset of ICNP® with a predominance of statements related to health deviation requirements, standing out for being the first terminological subset for the prevention of falls in the elderly in the context of primary care.

Exploring Nursing Care for Patients With COVID-19 Using International Classification for Nursing Practice-Based Nursing Records

This study explored nursing care topics for patients with the coronavirus disease 2019 admitted to the wards and intensive care units using International Classification for Nursing Practice-based nursing narratives. A total of 256630 nursing statements from 555 adult patients admitted from December 2019 to June 2022 were extracted from the clinical data warehouse. The International Classification for Nursing Practice concepts mapped to 301 unique nursing statements that accounted for the top 90% of all cumulative nursing narratives were used for analysis. The standardized number of nursing statements for each concept was calculated according to the types of nursing care and compared between the two groups. The most documented topics were related to infection; physical symptoms such as sputum, cough, dyspnea, and shivering; and vital signs including blood oxygen saturation and body temperature. Nurses in the intensive care units frequently documented concepts related to the directly monitored and assessed physical signs such as consciousness, pupil reflex, and skin integrity, whereas nurses in wards documented more concepts related to symptoms patients complained. This study showed that the International Classification for Nursing Practice-based nursing records can be used as source of information to identify nursing care for patients with coronavirus disease 19.

Creating Subsets of International Classification for Nursing Practice Precoordinated Concepts: Diagnoses/Outcomes and Interventions Categorized Into Areas of Nursing Practice

The International Classification for Nursing Practice is a comprehensive terminology representing the domain of nursing practice. A categorization of the diagnoses/outcomes and interventions may further increase the usefulness of the terminology in clinical practice. The aim of this study was to categorize the precoordinated concepts of the International Classification for Nursing Practice into subsets for nursing diagnoses/outcomes and interventions using the structure of an established documentation model. The aim was also to investigate the distribution of the precoordinated concepts of the International Classification for Nursing Practice across the different areas of nursing practice. The method was a descriptive content analysis using a deductive approach. The VIPS model was used as a theoretical framework for categorization. The results showed that all the precoordinated concepts of the International Classification for Nursing Practice could be categorized according to the keywords in the VIPS model. It also revealed the parts of nursing practice covered by the concepts of the International Classification for Nursing Practice as well as the parts that needed to be added to the International Classification for Nursing Practice. This has not been identified in earlier subsets as they covered only one specific area of nursing.

Identification of North American Nursing Diagnosis Association-Nursing Interventions Classification-Nursing Outcomes Classification of nursing home residents using on-time data by android smartphone application by registered nurses

PURPOSE

We aimed to investigate the nursing process linkages formed by Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) according to the primary NANDA-I diagnoses by registered nurses (RNs), customized to nursing home (NH) residents in Korea, using a developed smartphone application for NH RNs.

METHODS

This is a retrospective descriptive study. Applying quota sampling, a total of 51 NHs from all operating 686 NHs hiring RNs participated in this study. Data were collected from June 21 to July 30, 2022. Data on NANDA-I, NIC, NOC (NNN) of nurses applied to the NH residents were collected through a developed smartphone application. The application consists of general organization and residents' characteristics, NANDA-I, NIC, and NOC. RNs selected randomly up to 10 residents and NANDA-I with risk factors and related factors over the past 7 days, followed by all applied interventions out of 82 NIC. RNs then evaluated residents through 79 selected NOC.

RESULTS

We found the frequently used NANDA-I diagnoses, Nursing Interventions Classifications and Nursing Outcomes and Classifications applied for NH residents by RNs and developed the top five NOC linkages used to build care plan.

CONCLUSION

It is time to pursue high-level evidence and reply to the questions raised in NH practice using NNN with high technology. The outcomes for patients and nursing staff are improved by the continuity of care made possible by uniform language.

IMPLICATIONS FOR NURSING PRACTICE

NNN linkages should be used to construct and utilize the coding system of electronic health records or electronic medical records in Korean long-term care facilities.

Urinary incontinence in women: assessment with the aid of standardized nursing terminologies NANDA-I and NOC

OBJECTIVES

to assess urinary impairment in incontinent women with the aid of standardized nursing terminologies NANDA-I and NOC.

METHODS

a cross-sectional study, carried out with 97 women attending the gynecology outpatient clinic of a university hospital. Data collection took place using a form that contained information about NANDA-I diagnoses related to urinary incontinence and NOC Urinary Continence indicators. Statistical analysis was performed to assess the impairment of NOC indicators in the presence of NANDA-I nursing diagnoses.

RESULTS

diagnosis Mixed Urinary Incontinence was the most prevalent (43.3%), and, in its presence, the most compromised indicators were voids in appropriate receptacle, gets to toilet between urge and passage of urine and empties bladder completely.

CONCLUSIONS

urinary impairment was worse in women with elements of stress and urge urinary incontinence.

Construction and validation of nursing diagnoses for premature newborns

OBJECTIVE

To build and validate nursing diagnoses based on the International Classification of Nursing Practice (ICNP®) for premature newborns admitted to the Neonatal Intensive Care Unit.

METHOD

Methodological study based on the Brazilian method for developing subsets: use of specialized nursing language terms, construction of diagnostic statements and content validation of the statements by 40 specialist nurses. Those with a Content Validity Index (CVI) ≥ 0.80, organized according to Wanda Horta's basic human needs theory, were considered valid.

RESULTS

146 nursing diagnosis statements were constructed and 145 (93.3%) diagnoses were validated, with a predominance of the human need for cutaneous-mucosal integrity.

CONCLUSION

The specificity of neonatal care is evident when these diagnoses are presented and validated in order to support nurses in their clinical reasoning and decision-making.

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

AIMS

To explore the impact of 12 American Nurses Association recognized standardized nursing terminologies (SNTs) on patient and organizational outcomes.

BACKGROUND

Previous studies reported an effect of SNTs on outcomes, but no previous frameworks nor meta-analyses were found.

DESIGN

Systematic review and meta-analyses.

REVIEW METHODS

PubMed, Scopus, CINAHL, and OpenGrey databases were last consulted in July 2021. All abstracts and full texts were screened independently by two researchers. The review included primary quantitative studies that reported an association between recognized SNTs and outcomes. Two reviewers independently assessed the risk of bias and certainty of evidence for each meta-analyzed outcome using the "Grading of Recommendations, Assessment, Development and Evaluation" (GRADE) approach.

RESULTS

Fifty-three reports were included. NANDA-NIC-NOC and Omaha System were the most frequently reported SNTs used in the studies. Risk of bias in randomized controlled trials and not-randomized controlled trials ranged from high to unclear, this risk was low in cross-sectional studies. The number of nursing diagnoses NANDA-I moderately correlated with the intensive care unit length of stay (r = 0.38; 95% CI = 0.31-0.44). Using the Omaha System nurse-led transitional care program showed a large increase in both knowledge (d = 1.21; 95% CI = 0.97-1.44) and self-efficacy (d = 1.23; 95% CI = 0.97-1.48), while a reduction on the readmission rate (OR = 0.46; 95% CI = 0.09-0.83). Nursing diagnoses were found to be useful predictors for organizational (length of stay) and patients' outcomes (mortality, quality of life). The GRADE indicated that the certainty of evidence was rated from very low to low.

CONCLUSIONS

Studies using SNTs demonstrated significant improvement and prediction power in several patients' and organizational outcomes. Further high-quality research is required to increase the certainty of evidence of these relationships.

CLINICAL RELEVANCE

SNTs should be considered by healthcare policymakers to improve nursing care and as essential reporting data about patient's nursing complexity to guide reimbursement criteria.

The Curious Case of Alagille Syndrome: A Case Report With NANDA-I Classification, NIC, and NOC Linkage to the Patient Care Plan

Alagille syndrome is a rare and complex pleiotropic multisystem disorder caused by an autosomal dominant genetic mutation of JAG1 (90%) and NOTCH2 (1%-2%) genes located on the short arm of chromosome 20. This case is reported as per the CA se RE ports (CARE) guidelines (2013). A 14-year-old boy who is a known case of chronic cholestatic liver disease of neonatal onset, was diagnosed with Alagille syndrome as evident from a NOTCH 2 mutation in genetic analysis and paucity of intrahepatic bile ducts on biopsy. He presented with portal hypertension, growth failure, and persistent hyperbilirubinemia. This case highlights the gamut of multisystem dysfunctions faced by this child. He is currently on conservative management and worked up for liver transplantation. The condition is often rare and challenging due to the multisystem pathogenesis. Thus, the nursing care is also multifaceted. This case study identified relevant North American Nursing Diagnosis Association (NANDA) Classification, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) concepts to describe care of children with Alagille syndrome based on actual patient data.

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.

Comparison of SIREN social needs screening tools and Simplified Omaha System Terms: informing an informatics approach to social determinants of health assessments

OBJECTIVE

Numerous studies indicate that the social determinants of health (SDOH), conditions in which people work, play, and learn, account for 30%-55% of health outcomes. Many healthcare and social service organizations seek ways to collect, integrate, and address the SDOH. Informatics solutions such as standardized nursing terminologies may facilitate such goals. In this study, we compared one standardized nursing terminology, the Omaha System, in its consumer-facing form, Simplified Omaha System Terms (SOST), to social needs screening tools identified by the Social Interventions Research and Evaluation Network (SIREN).

MATERIALS AND METHODS

Using standard mapping techniques, we mapped 286 items from 15 SDOH screening tools to 335 SOST challenges. The SOST assessment includes 42 concepts across 4 domains. We analyzed the mapping using descriptive statistics and data visualization techniques.

RESULTS

Of the 286 social needs screening tools items, 282 (98.7%) mapped 429 times to 102 (30.7%) of the 335 SOST challenges from 26 concepts in all domains, most frequently from Income, Home, and Abuse. No single SIREN tool assessed all SDOH items. The 4 items not mapped were related to financial abuse and perceived quality of life.

DISCUSSION

SOST taxonomically and comprehensively collects SDOH data compared to SIREN tools. This demonstrates the importance of implementing standardized terminologies to reduce ambiguity and ensure the shared meaning of data.

CONCLUSIONS

SOST could be used in clinical informatics solutions for interoperability and health information exchange, including SDOH. Further research is needed to examine consumer perspectives regarding SOST assessment compared to other social needs screening tools.

Examining standardized consumer-generated social determinants of health and resilience data supported by Omaha System terminology

Nursing terminologies like the Omaha System are foundational in realizing the vision of formal representation of social determinants of health (SDOH) data and whole-person health across biological, behavioral, social, and environmental domains. This study objective was to examine standardized consumer-generated SDOH data and resilience (strengths) using the MyStrengths+MyHealth (MSMH) app built using Omaha System. Overall, 19 SDOH concepts were analyzed including 19 Strengths, 175 Challenges, and 76 Needs with additional analysis around Income Challenges. Data from 919 participants presented an average of 11(SD = 6.1) Strengths, 21(SD = 15.8) Challenges, and 15(SD = 14.9) Needs. Participants with at least one Income Challenge (n = 573) had significantly (P < .001) less Strengths [9.4(6.4)], more Challenges [27.4(15.5)], and more Needs [15.1(14.9)] compared to without an Income Challenge (n = 337) Strengths [13.4(4.5)], Challenges [10.5(8.9)], and Needs [5.1(10.0)]. This standards-based approach to examining consumer-generated SDOH and resilience data presents a great opportunity in understanding 360-degree whole-person health as a step towards addressing health inequities.

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.

FHIR-up! Advancing knowledge from clinical data through application of standardized nursing terminologies within HL7® FHIR®

Health Level 7®'s (HL7) Fast Healthcare Interoperability Resources® (FHIR®) is leading new efforts to make data available to healthcare clinicians, administrators, and leaders. Standardized nursing terminologies were developed to enable nursing's voice and perspective to be visible within the healthcare data ecosystem. The use of these SNTs has been shown to improve care quality and outcomes, and to provide data for knowledge discovery. The role of SNTs in describing assessments and interventions and measuring outcomes is unique in health care, and synergistic with the purpose and goals of FHIR. FHIR acknowledges nursing as a discipline of interest and yet the use of SNTs within the FHIR ecosystem is rare. The purpose of this article is to describe FHIR, SNTs, and the potential for synergy in the use of SNTs with FHIR. Toward improving understanding how FHIR works to transport and store knowledge and how SNTs work to convey meaning, we provide a framework and examples of SNTs and their coding for use within FHIR solutions. Finally, we offer recommendations for the next steps to advance FHIR-SNT collaboration. Such collaboration will advance both nursing specifically and health care in general, and most importantly, improve population health.

Utilizing standardized nursing terminologies in implementing an AI-powered fall-prevention tool to improve patient outcomes: a multihospital study

OBJECTIVES

Standardized nursing terminologies (SNTs) are necessary to ensure consistent knowledge expression and compare the effectiveness of nursing practice across settings. This study investigated whether SNTs can support semantic interoperability and outcoming tracking over time by implementing an AI-powered CDS tool for fall prevention across multiple EMR systems.

MATERIALS AND METHODS

The study involved 3 tertiary academic hospitals and 1 public hospital with different EMR systems and nursing terms, and employed an AI-powered CDS tool that determines the fall risk within the next hour (prediction model) and recommends tailored care plans (CDS functions; represented by SNTs). The prediction model was mapped to local data elements and optimized using local data sets. The local nursing statements in CDS functions were mapped using an ICNP-based inpatient fall-prevention catalog. Four implementation models were compared, and patient outcomes and nursing activities were observed longitudinally at one site.

RESULTS

The postimplementation approach was practical for disseminating the AI-powered CDS tool for nursing. The 4 hospitals successfully implemented prediction models with little performance variation; the AUROCs were 0.8051-0.9581. The nursing process data contributed markedly to fall-risk predictions. The local nursing statements on preventing falls covered 48.0%-86.7% of statements. There was no significant longitudinal decrease in the fall rate (P = .160, 95% CI = -1.21 to 0.21 per 1000 hospital days), but rates of interventions provided by nurses were notably increased.

CONCLUSION

SNTs contributed to achieving semantic interoperability among multiple EMR systems to disseminate AI-powered CDS tools and automatically track nursing and patient outcomes.

Knowledge translation for nursing care for patients with Risk of perioperative positioning injury: A case report

PURPOSE

The aim was to apply the Advanced Nursing Process and demonstrating procedures of surgical positioning, as well as to show the participating the Nursing Outcomes Classification findings in order to translate the knowledge on specific preventive perioperative positioning into practice, the review of clinical protocols and nursing care plan.

METHODS

The methods used include case report about knowledge translation by applying training modalities, review and adaptation of clinical protocols and examination of nursing care plans.

FINDINGS

One hundred and nine healthcare providers attended the training, including nurses and nursing technicians working in the surgical center and the outpatient surgical center of the hospital chosen for this study. The surgical positioning protocols were revised based on the evidence described in the literature and the main surgical guidelines. The review of care registered in the institution's electronic system for the nursing prescription stage of the diagnosis Risk of perioperative positioning injury was based on the review on evidence on risk factors, the main guidelines in the area and the interventions suggested by Nursing Intervention Classification. The electronic system had registered 14 cares for this diagnosis, and after the review, one care was excluded and eight new cares were included, totaling 21 cares.

CONCLUSION

Nursing teams play a prominent role in positioning patients for surgery, protecting them in a moment of extreme vulnerability, thus making knowledge about the fundamental elements of surgical positioning essential. This emphasizes the importance of training, and of reviewing protocols and records of procedures that promote safety to patients and care teams.

IMPLICATION FOR NURSING PRACTICE

The translation of knowledge about the Advanced Nursing Process in the perioperative area contributes to the refinement of classifications and standardization of language in this scenario, subsidizing an evidence-based clinical practice.

Heuristic smartphone usability evaluations of the mobile application NANDA, nursing interventions classification, and nursing outcomes classification customized for nursing home registered nurses

PURPOSE

We aimed to evaluate the usability of a smartphone application consisting of standardized nursing language (SNL) using NANDA, Nursing Intervention Classification, and Nursing Outcome Classification for nursing home nurses.

DATA SOURCES

Applying convenience sampling, a total of 14 experts and 15 real users were invited to test and evaluate the smartphone application independently. For the usability evaluation of the developed application, the Korean version of the Mobile Application Rating Scale for experts and Mobile Application Rating Scale: User Version developed by Stoyanov et al. were used.

DATA SYNTHESIS

Both groups determined that the SNL application was quite informative about SNL and efficient function; however, the engagement was quite lower than other categories.

CONCLUSIONS

Although SNLs were scientifically developed for several decades, the widely available technological application for registered nurses in different languages is urgently needed to improve quality of nursing care.

IMPLICATIONS FOR NURSING PRACTICE

The identified problems and recommendations by users and experts using heuristic evaluation will be reflected in the application's final version to be used for research.

Evaluation of the effectiveness of nursing interventions in research from Brazilian postgraduation programs

PURPOSE

The purpose of this study was to evaluate research from Brazilian postgraduate students who provide evidence of effectiveness for Nursing Interventions Classification (NIC).

METHODS

We conducted a literature review study of thesis and dissertations available in the Brazilian Digital Library of Dissertations and Theses (D/T) in May 2021 regardless of the year they were conducted. In those studies that did not utilize the NIC in the effectiveness evaluation, the cross-mapping methodology was employed between NIC and the interventions used by the authors of the studies.

RESULTS

Using a systematic process, we identified 91 studies. Twenty-seven met a priori inclusion and exclusion criteria. We found an increase in studies that focused on nursing interventions in the last 10 years (n = 19), a large proportion of clinical trials (n = 16), and the majority of articles from the Southeast region of Brazil (n = 20). The areas of focus were adult and elderly care, and with a special interest in the behavioral domain (n = 11). Two sensitivity criteria were identified in all D/T (n = 27), and each study presented evidence of effectiveness of a minimum of three criteria simultaneously.

CONCLUSIONS

Based on the effectiveness criteria, the Brazilian scientific production in postgraduate programs carried out by nurses provides evidence of the effectiveness for NIC nursing interventions.

IMPLICATIONS FOR NURSING PRACTICE

It is recommended to conduct further research that uses the NIC in the planning, conduct, and evaluation of interventions, based on effectiveness criteria of nursing sensitivity.

Using Nursing Interventions Classifications to Document Faith Community Nursing Transitional Care

ABSTRACT

One out of five Medicare beneficiaries is readmitted within 30 days after hospital discharge, and as many as three in four readmissions are preventable. This study describes transitional care interventions (TCIs) delivered by one faith community nurse (FCN) to at-risk seniors living in a certain ZIP code. Two years of nursing documentation (2,280 interventions) were translated into Nursing Interventions Classification standardized nursing language. Results indicate the FCN provided priority TCIs including spiritual care. In fully describing TCIs using a nursing language, results support that the FCN transitional care model is a method worth exploring to provide wholistic transitional care.

Analysis of gender perspective in the use of NANDA-I nursing diagnoses: A systematic review

AIM

To identify, describe and analyse the gender perspective in the use of the diagnoses contained in the NANDA-I taxonomy in observational studies published in the scientific literature.

DESIGN AND METHODS

A systematic review has been conducted spanning from 2002 to 2020. The most frequent NANDA-I nursing diagnoses in care plans reported in observational studies, and the defining characteristics and related factors identified for men and women have been described. The Preferred Reporting Items for Systematic Reviews (PRISMA-P) have guided our research. The main findings have been summarized using a descriptive narrative synthesis approach.

RESULTS

Forty-one articles were included in our study. With regard to gender analysis, the percentage of men and women that make up the sample were not specified in all articles, and half of the studies did not identify gender either in the diagnosis label or in their defining characteristics or related factors. Based on the reviewed articles, gender perspectives are not systematically incorporated in the use of the NANDA-I diagnosis. Therefore, gender biases in its use in the scientific literature may exist. This situation poses barriers to determine the health responses that are different and unequal between women and men.

The effect of discharge training developed based on nursing interventions classification (NIC) on surgical recovery in oncology patients: Randomized controlled trial - A pilot study

AIM

To investigate the effect of discharge training on surgical recovery in oncology patients.

DESIGN

A two-arm parallel-group randomized controlled trial (RCT) registered at clinicaltrials.gov (NCT04862104) and reporting according to the CONSORT checklist.

METHODS

The study was conducted with 78 patients who had undergone cancer surgery in a university hospital. The intervention group took discharge training; the control group received routine care. The surgical recovery was measured before discharge and 2, 4 and 8 weeks after the discharge.

RESULTS

There was a higher surgical recovery score in the intervention group compared with the usual care group at the second, fourth and eighth week after discharge. This study is expected to support discharge training as enhancing recovery in oncology surgical patients.

CONCLUSION

This pilot study shows that discharge training developed based on the Nursing Intervention Classification can be used in clinics to enhance the surgical recovery of patients.

Nursing Care Plan for a Newborn with the Defect of Congenital Gastroschisis in the Postoperative Period Using ICNPTM and the Dedicated Software

Background: Congenital defect gastroschisis manifests as a defect in the sheath in the intestine of the newborn, which is not covered by the hernia sac. In this case, the priority task of the neonatal nurse is to diagnose patient care problems quickly and accurately. Choosing the correct care plan elements has a significant impact on shortening the duration of hospitalization, reducing the number and severity of complications, and preventing their recurrence. The purpose of this study was to formulate a care plan for a newborn with diagnosed congenital defect gastroschisis in the postoperative period, using the International Classification for Nursing Practice (ICNP^TM) within the nursing documentation and decision support system, the “ADPIECare Dorothea” software. Methods: After a review of the relevant literature and nursing documentation, a case study of a newborn with the congenital defect gastroschisis was described. A care plan was prepared using ICNP and the “ADPIECare” software. Results: It was possible to organize and standardize care plans to provide consistent and comprehensive professional nursing care. The system supporting nursing decisions suggested interventions personalized for the nursing diagnoses and to the patient needs. Conclusions: Our findings can help to optimize the nurse’s work organization to improve health care quality, outcomes, and effectiveness.

[The use of International Classification for Nursing Practice (ICNP) in pediatric and neonatal settings: literature review]

INTRODUCTION

Literature reports that the use of Standardized Nursing Terminology contributes to a better implementation of nursing care and patients' safety and to do research. ICNP  is an international and combinatorial standard terminology proposal by ICN, adaptable to different settings, among which paediatric and neonatal.

METHODS

A literature review on different databases (Medline/Pubmed, CINAHL, Embase, Web of Science and Scopus) was conducted to investigate the use of ICNP  in professional practice in paediatric and neonatal settings.

RESULTS

44 papers were included in the review; 33 of which focused on the paediatric setting while 11 on the neonatal setting. It is evident ICNP  is usable in both settings, permitting to describe nursing care to different age groups, in-hospital, out-of-hospital and in specific clinical situations.

DISCUSSION

ICNP  is up to the task of describing nursing care, implementing nursing care plans, analysing types of nursing care for management aims, studying concepts or specific pediatric or neonatal situations. ICNP  is adaptable to different nursing frameworks and models. Few studies analyses ICNP  implementation or effectiveness in clinical settings. Additional research is needed to verify ICNP  effectiveness in paediatric and neonatal settings and to implement contextual catalogues.

Effectiveness of Standardized Nursing Terminologies for Nursing Practice and Healthcare Outcomes: A Systematic Review

PURPOSE

This review evaluates the effectiveness of using standardized terminologies in nursing.

METHODS

A systematic literature review was performed via PubMed, Web of Science, CINAHL, and OVID databases for articles published between January 1973 and September 2020. The Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies was used to assess the quality of all included studies.

RESULTS

Fourteen studies were selected for data extraction and analysis, which included a total of 24,243 patients and 99 nurses. Of the studies that met the inclusion criteria, the quality of five were of high quality, one was of moderate quality, and eight was of weak quality. All articles were summarized according to two themes: the identification of common outcomes or interventions, and the validation or evaluation of the effectiveness of standard nursing terminology sets.

CONCLUSION

Standardized terminologies in nursing help nurses to implement care plans according to nursing procedures, supervise changes in patients' sensitive indicators, improve patients' health outcomes, and contribute to evidence-based nursing practices and global data resource sharing.

IMPLICATIONS FOR NURSING PRACTICE

Standardized nursing terminologies have positive effects on clinical practice, are essential for enriching nurses' knowledge, and alter nurses' attitudes regarding education and guidance, which promotes the clinical application of these terminologies.

Patients' Expressed Nursing Care Needs in a Forensic Psychiatric Setting

The aim of this study was to describe the patients' nursing care needs in a forensic psychiatric setting in line with the NANDA-I classification. Ten patients sentenced to forensic psychiatric care were interviewed. Data were analyzed by means of directed content analysis with a deductive approach, where we used "served time" as a factor in the analysis, thus creating three categories: newly arrived patients with a length of stay of only a couple of years, patients with a length of stay of around 5 years, and patients with a length of stay of more than 5 years. Thirteen NANDA-I diagnoses were identified during the analyses, distributed on seven different domains. When distributing the given NANDA-I diagnoses according to the created categories, an explanatory pattern emerged, and three themes became apparent: denial, insight, and listlessness. Considering the differences in views, the patients' own recognition of what is a problem, a potential, or a risk could improve a "working relation" and, eventually, a recovery. NANDA-I nursing diagnoses may improve individualized and person-centered care as NANDA-I makes care continuously consistent over time.

Translation and cross-cultural adaptation of the Clinical Care Classification system

INTRODUCTION

The Clinical Care Classification (CCC) system is one of the standard nursing terminologies recognized by the American Nurses Association, developed to describe nursing care through electronic documentation in different healthcare settings. The translation of the CCC system into languages other than English is useful to promote its widespread use in different countries and to provide the standard nursing data necessary for interoperable health information exchange. The aim of this study was to translate the CCC system from English to Italian and to test its clinical validity.

METHODS

A translation with cross-cultural adaptation was performed in four phases: forward-translation, back-translation, review, and dissemination. Subsequently a pilot cross-mapping study between nursing activities in free-text nursing documentation and the CCC interventions was conducted.

RESULTS

All elements of the CCC system were translated into Italian. Semantic and conceptual equivalences were achieved. Altogether 77.8% of the nursing activities were mapped into CCC interventions.

CONCLUSIONS

The CCC system, and its integration into electronic health records, has the potential to support Italian nurses in describing and providing outcomes and costs of their care in different healthcare settings. Future studies are needed to strengthen the impact of the CCC system on clinical practice.

Use of standardized terminologies in clinical practice: A scoping review

AIM

To explore the use and impact of standardized terminologies (STs) within nursing and midwifery practice.

INTRODUCTION

The standardization of clinical documentation creates a potential to optimize patient care and safety. Nurses and midwives, who represent the largest proportion of the healthcare workforce worldwide, have been using nursing-specific and multidisciplinary STs within electronic health records (EHRs) for decades. However, little is known regarding ST use and impact within clinical practice.

METHODS

A scoping review of the literature was conducted (2019) across PubMed, CINAHL, Embase and CENTRAL in collaboration with the Five Country Nursing and Midwifery Digital Leadership Group (DLG). Identified studies (n = 3547) were reviewed against a number of agreed criterion, and data were extracted from included studies. Studies were categorized and findings were reviewed by the DLG.

RESULTS

One hundred and eighty three studies met the inclusion criteria. These were conducted across 25 different countries and in various healthcare settings, utilising mainly nursing-specific (most commonly NANDA-I, NIC, NOC and the Omaha System) and less frequently local, multidisciplinary or medical STs (e.g., ICD). Within the studies, STs were evaluated in terms of Measurement properties, Usability, Documentation quality, Patient care, Knowledge generation, and Education (pre and post registration). As well as the ST content, the impact of the ST on practice depended on the healthcare setting, patient cohort, nursing experience, provision of education and support in using the ST, and usability of EHRs.

CONCLUSION

Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and generalize findings.

Availability of Standardized Electronic Patient Data in Nursing: A Nationwide Survey of Austrian Acute Care Hospitals

A large amount of patient data is produced and documented in patient care. Health care professionals expect that this routinely collected patient data can also be used for secondary purposes such as measuring the quality of care or to gain new knowledge. Routine data needs to be documented in a standardized form, based on clinical terminologies, to allow this secondary use of data. In Austria, hospitals are currently moving from paper-based documentation to computer-based documentation, but parts of the documentation are still done in paper-based form or without using clinical terminologies, especially in nursing. This study aims to analyze the availability of standardized electronic patient data in nursing in Austria. We conducted an online survey of 32 senior nursing managers at 32 Austrian hospitals. The study showed that 79% of hospitals use electronic health records for nursing documentation, but only 29% of the nursing care plans are documented in a standardized way using standardized nursing classification systems such as NANDA-I.

Paths taken by Brazilian Nursing for the development of terminological subsets

OBJECTIVE

to discuss the paths taken by Brazilian Nursing in the development of terminological subsets of the International Classification for Nursing Practice.

METHOD

documentary research, carried out in master's dissertations and doctoral theses, which developed terminological subsets, available at the Bank of Doctoral Theses and Master's Dissertations of the Under-graduation Personnel Improvement Coordination. The variables were analyzed were institution, year; academic level, type of health service, methodological approach, clientele, theoretical reference, validation of terms, cross mapping, modeling of new concepts, validation of statements, method used for elaboration, term collection, finalization and dissemination.

RESULTS

124 doctoral theses and master's dissertations were found, 91 were excluded and 33 were included, 23 (69.70%) of which were master's dissertations, with the highest production in 2014 (n=10; 30.30%), with emphasis on the Northeast (36.36%); the 'Primary Care' scenario, with six studies (18.18%); and the predominant clientele was cancer patients. As for the methodological characteristics, in 96% of the studies, the quantitative approach was used; in 2%, a qualitative approach; and 2% associated the quantitative and qualitative approaches. As for the type of study, 60% were methodological and 24% descriptive-exploratory, with the Horta model being the most used (36%).

CONCLUSION

the paths are successful, yet still permeated by weaknesses in the validations and potentialities to standardize the language.

Standardized language systems for the design of high-fidelity simulation scenarios: A Delphi study

PURPOSE

This study aimed to identify which of the standardised Nursing Interventions Classification (NIC) activities should be used in the design of clinical cases with high fidelity simulation for educational preparation of undergraduate nursing students in non-technical skills.

DESIGN AND METHODS

A three-round Delphi study was carried out: the first round with taxonomy experts, the second round with academic and clinical lecturers with limited experience in the simulation-based learning methodology, and the third round with academic and clinical lecturers having at least two years of simulation experience. The NIC interventions were grouped into two levels of competence in accordance with the undergraduate nursing degree curriculum (1st- and 2nd-year students, the "novice" level; 3rd- and 4th-year students, the "advanced" level). The NIC allows the description of nurse student competencies in multiple clinical scenarios and throughout various contexts: theory, clinical practice and simulation.

FINDINGS

The experts identified 163 interventions in 8 areas as relevant and feasible, selecting 42 for the "novice" students, in Nursing Fundamentals (13) and Adult Nursing Care 1 (29), and 97 for the "advanced" students: Maternity Care and Child Health Nursing (18), Mental Health (13), Nursing Care of Older People (12), Community Health Nursing (20) and Adult Nursing Care 2 (34). In addition, 24 interventions were identified as cross-cutting, with training to be provided across all four years of the degree.

CONCLUSION

A total of 163 interventions of the NIC list were selected by experts as being both relevant and feasible to nursing undergraduate education. This creates the favourable framework to design high-fidelity scenarios for the training of non-technical skills according to the competences required and in line with the health care reality. Therefore, enabling an optimal combination of theoretical education by academic lecturers with practical training by clinical lecturers and staff nurses.

Identifying nurses' concern concepts about patient deterioration using a standard nursing terminology

OBJECTIVES

Nurse concerns documented in nursing notes are important predictors of patient risk of deterioration. Using a standard nursing terminology and inputs from subject-matter experts (SMEs), we aimed to identify and define nurse concern concepts and terms about patient deterioration, which can be used to support subsequent automated tasks, such as natural language processing and risk predication.

METHODS

Group consensus meetings with nurse SMEs were held to identify nursing concerns by grading Clinical Care Classification (CCC) system concepts based on clinical knowledge. Next, a fundamental lexicon was built placing selected CCC concepts into a framework of entities and seed terms to extend CCC granularity.

RESULTS

A total of 29 CCC concepts were selected as reflecting nurse concerns. From these, 111 entities and 586 seed terms were generated into a fundamental lexicon. Nursing concern concepts differed across settings (intensive care units versus non-intensive care units) and unit types (medicine versus surgery units).

CONCLUSIONS

The CCC concepts were useful for representing nursing concern as they encompass a nursing-centric conceptual framework and are practical in lexicon construction. It enabled the codification of nursing concerns for deteriorating patients at a standardized conceptual level. The boundary of selected CCC concepts and lexicons were determined by the SMEs. The fundamental lexicon offers more granular terms that can be identified and processed in an automated fashion.

[Relevance of NANDA-I Diagnosis in Hematopoietic stem cell transplantation patients]

INTRODUCTION

Haematopoietic stem cell transplantation (HSCT) has become the standard of care for many haematological diseases unresponsive to traditional treatments; pretransplant therapy still causes high mortality and morbidity today. Due to the high risk, patient care requires careful assessment and often complex, intensive and non-risk free interventions; the NANDA-I classification provides a way to classify and standardise areas of nursing interest. In 2011, Speksnijder, using the Delphi technique, identified 68 diagnoses relevant to identify health problems in the field of oncohaematology.

AIM

Based on Speksnijder's contribution, the study tries to identify which of these diagnoses were relevant in identifying health problems in HSCT patients.

METHOD

A quantitative-descriptive study was carried out; a structured questionnaire on a 4-point Likert scale was used to build consensus, involving 57 expert nurses enrolled in the Italian GITMO Centres.

RESULTS

Of the 68 NANDA-I diagnoses defined as relevant by Speksnijder in the oncohaematological field, this study identified 37 as relevant in detecting health problems in patients undergoing HSCT (34 in Round 1, 3 in Round 2) and also defined 12 as important diagnoses having obtained an absolute consensus.

DISCUSSION

Using the NANDA-I diagnoses to identify, from a panel of experts, the most important and relevant health problems associated with the toxicity of pre-TCSE treatment, allows to focus attention on expected and known outcomes in order to be able to intervene with performances aimed at reducing specific risks and complications.

Psychometric Evaluation of the Nursing Outcome Knowledge: Pain Management in People with Chronic Pain

Pain has a major impact on health and quality of life. Since the level of knowledge of painful conditions can influence how these are addressed and managed, assessing this knowledge in patients becomes crucial. As a result, it is necessary to have culturally adapted and validated instruments that specifically measure patients' knowledge of chronic pain management. The objective of this study was to carry out the Spanish cultural adaptation and the validation of the outcome Knowledge: Pain Management of the Nursing Outcomes Classification (NOC) in patients with chronic pain, defined as extent of understanding conveyed about causes, symptoms, and treatment of pain. A three-stage study was designed: 1) translation and cultural adaptation through an expert panel, 2) content validation, 3) clinical validation. This study provides nurses with a Spanish version of this scale adapted to their context, as well as a set of structured indicators to measure patients' knowledge about chronic pain. The results indicated that the culturally adapted Spanish version of the outcome Knowledge: Pain Management had a high level of content validity (CVI = 0.92), with 27 indicators being distributed between two factors. This version has been shown to be reliable in terms of inter-observer agreement (κ = 0.79) and internal consistency (α = 0.95). In conclusion, Knowledge: Pain Management has been shown to be reliable and valid to measure knowledge of chronic pain.

Exploring reporting quality of systematic reviews and Meta-analyses on nursing interventions in patients with Alzheimer's disease before and after PRISMA introduction

BACKGROUND

Systematic reviews (SRs) and meta-analyses (MAs) are distillation of current best available evidence, but are potentially prone to bias. The bias of SRs and MAs comes from sampling bias, selection bias and within study bias. So, their reporting quality is especially important as it may directly influence their utility for clinicians, nurses, patients and policy makers. The SRs and MAs on nursing interventions in patients with Alzheimer's disease (AD) have been increasingly published over the past decade, but the reporting quality of article has not been evaluated after the introduction of Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) Statement.

METHODS

According to the inclusion and exclusion criteria, we searched the databases including PubMed, EMBASE and The Cochrane Library from inception through October 16th 2018. Two reviewers independently selected articles and extracted data. The PRISMA checklist was adopted to evaluate reporting quality. Comparisons were made between studies published before (2001-2009) and after (2011-2018) its introduction.

RESULTS

A total of 77 eligible articles, 18 (23.4%) were published before the PRISMA Statement and 59 (76.6%) were published afterwards. There was higher score after publication of the PRISMA Statement than before (20.83 ± 3.78 vs 17.11 ± 4.56, P <  0.05). There was an improvement in the following items after the PRISMA statement was released (P <  0.05): title (item 1, 50.0% vs 74.6%, OR = 3.10, 95CI%: 1.00-9.61), search (item8, 27.8% vs 57.6%,OR = 3.25, 95CI%: 1.14-9.28), study selection (item 9, 44.4% vs 81.4%,OR = 6.28, 95CI%: 1.93-20.37), Data collection process (item 10, 50.0% vs 76.3%,OR = 3.45, 95CI%:1.10-10.84), risk of bias in individual studies (item 12, 50.0% vs 83.1%, OR = 5.78, 95CI%:1.71-19.52), risk of bias across studies (item15, 5.6% vs 28.8%,OR = 3.60, 95CI%:1.04-12.43), study characteristics (item 18, 77.8% vs 98.3%, OR = 28.13, 95CI%:3.35-236.19), risk of bias with studies (item 19, 50.0% vs 83.1%, OR = 5.78, 95CI%:1.71-19.52), results in individual studies (item 20, 72.2% vs 94.9%, OR = 11.09, 95CI%:1.99-61.82), conclusions (item 26, 77.8% vs 98.3%, OR = 28.13, 95CI%:3.35-236.19). After controlling for the confounding factors, there were higher PRISMA score for systematic reviews including meta-analyses, protocol or registration, can't answer of RCT, journal source of SCI (Science Citation Index), manuscript length > 13 page and funding support.

CONCLUSION

Since the publication of the PRISMA Statement, there has been an improvement in the quality of reporting of SRs and MAs on nursing interventions in patients with AD. More endorsement by journals of the report guideline for SRs/MAs may improve articles reporting quality, and the dissemination of reliable evidence to nurses. We recommend authors, readers, reviewers, and editors to become more acquainted with and to more strictly adhere to the PRISMA checklist.

Effect of 'nursing terminologies and classifications' course on nursing students' perception of nursing diagnosis

PURPOSE

To determine nursing students' perception of nursing diagnosis and the effect of 'nursing terminologies and classifications' course on this perception.

METHODS

This study was carried out as a quasi-experimental, two group design. Data were collected through the Nursing Diagnosis Survey.

FINDINGS

The overall Perceptions of Nursing Diagnosis Survey score for this study was found 2.44 ± 0.44. Perceptions of Nursing Diagnosis Survey mean scores of nursing students who took 'Nursing Terminologies and Classifications' course were found more positive than the nursing students who did not take the course.

CONCLUSIONS

Positive perceptions about the use of nursing diagnosis have beneficial effects on the identification of patient problems and planning of these; and improves the quality of the patient care.

Evidence of Progress in Making Nursing Practice Visible Using Standardized Nursing Data: a Systematic Review

Nursing care documentation in electronic health records (EHRs) with standardized nursing terminologies (SNTs) can facilitate nursing's participation in big data science that involves combining and analyzing multiple sources of data. Before merging SNTs data with other sources, it is important to understand how such data are being used and analyzed to support nursing practice. The main purpose of this systematic review was to identify studies using SNTs data, their aims and analytical methods. A two-phase systematic process resulted in inclusion and review of 35 publications. Aims of the studies ranged from describing most popular nursing diagnoses, outcomes, and interventions on a unit to predicting outcomes using multi-site data. Analytical techniques varied as well and included descriptive statistics, correlations, data mining, and predictive modeling. The review underscored the value of developing a deep understanding of the meaning and potential impact of nursing variables before merging with other sources of data.

Job titles need to reflect modern times and go gender neutral

The chance to update nursing and midwifery titles can not only help streamline the confusing array of roles, but ensure that trusts employ bona fide registrants, suggests Sam Foster, Chief Nurse, Oxford University Hospitals.

The Grieving Nursing Diagnoses in the Primary Healthcare Setting

PURPOSE

To estimate the prevalence of Grieving, risk for Complicated Grieving, and Complicated Grieving in the primary care setting.

METHODS

Retrospective epidemiological study, analyzing data from electronic health records (EHR).

FINDINGS

A total of 84% of the 9,063 records had diagnostic labels without defining characteristics, related factors, or risk factors. A larger frequency of complicated grieving was found in deceased mourners.

CONCLUSIONS

The grieving epidemiology opens new chances for the research using data from EHR.

PRACTICE IMPLICATIONS

The adequacy of the records is essential to develop a profile of the patient at risk of complications after the loss. This research is an important step to build an epidemiological basis for nursing diagnosis of grieving in the primary health care setting.

ICNP

The International Classification for Nursing Practice (ICNP^®) terminology was in 2016 implemented in three Norwegian municipalities through the introduction of five standardized care plans in the Electronic Patient Record (EPR) system. This poster provides results from an exploratory, qualitative study, investigating how nurses in these municipalities applied the care plans into their daily informational work.

Nursing Diagnoses Panorama in a Swedish Forensic Psychiatric Setting Using NANDA-International Taxonomy

More than 1,000 Swedish hospital beds are occupied by patients in forensic psychiatric settings; their average length of hospitalization is 3-7 years. In this context, nursing diagnoses could be extremely useful to make nursing care structured, measurable, and internationally comparable. The study aimed to describe nursing diagnoses in a Swedish forensic psychiatric setting.

METHODS

Data were collected from electronic patient records of 55 patients in a medium-secure forensic psychiatric setting in Sweden. Anonymized data were entered into a database where entries were transformed into figures. Descriptive statistics were used, and frequencies, means, and percentages were calculated. The variables employed were characteristics and related factors, according to NANDA-International (NANDA-I) and International Statistical Classification of Dieseases and Related Heatlh Problems, 10th Revision (ICD-10), diagnoses.

RESULTS

The patients had between 1 and 13 NANDA-I diagnoses each. Forty-one of the 55 patients had psychosis as the primary ICD-10 code. The identified nursing diagnoses described the patients' status upon arrival in the forensic psychiatric setting. Of the 55 patients, entries in the patient records describing 300 signs and symptoms (i.e., characteristics and related factors) were found. From these signs and symptoms, 371 entries that fit NANDA-I diagnoses were identified, representing 20 different NANDA-I diagnoses.

CONCLUSION

NANDA-I diagnoses individualize patient care, making care person centered. NANDA-I is used all over the world and has the potential to make nursing care structured, measurable, and internationally comparable.

Developing a subset of ICNP nursing diagnoses for medical and surgical hospital settings, informed by an Italian nursing conceptual model: a multicenter cross-sectional study

BACKGROUND

The International Classification for Nursing Practice (ICNP) is designed to facilitate the expression of nursing diagnoses, interventions and outcomes. The development of the ICNP subsets may support nurses by providing appropriate terms for documenting nursing care. This project aimed to develop a subset of ICNP nursing diagnoses oriented by an Italian Nursing Conceptual Model (MPI) to describe nursing clinical data in medical and surgical acute hospital wards.

STUDY DESIGN

A subset of ICNP nursing diagnoses was developed based on a literature review and on an expert consensus. A cross-sectional study was conducted in three Northern Italian hospitals to empirically test the subset in target settings.

METHODS

In accordance with the guidelines adopted by the International Council of Nursing, the study followed the process for developing an ICNP subset. Twelve expert nurses from clinical settings and nursing education in surgical and medical care participated in a Delphi method to further validate the subset. A cross-mapping process has been implemented and the prevalence of diagnoses was described. Data were collected from healthcare documentation of admitted patients, including, retrospectively, nursing clinical data from the patients' admission date to the time of data collection.

RESULTS

Documentation from 476 admitted patients was analysed: 228 were from surgical and 248 from medical wards. 24,142 nursing diagnoses were detected consulting retrospectively each documentation. A total number of 21,401 nursing diagnoses (88%) were fully mapped by the ICNP subset.

CONCLUSION

Results showed a high capability of ICNP terminology to describe nursing care in acute medical and surgical areas in Italian hospitals. The identified subset of ICNP diagnoses could be a valuable way to support a computerized documentation system for hospitals using MPI and ICNP. Results could be used to start revising nursing education programs in order to introduce this nursing standardized terminology combining it with the nursing conceptual model in use.

Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems

OBJECTIVE

Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC) related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults.

METHODS

Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms.

RESULTS

Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop.

CONCLUSION

This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.Objetivo.Construir definições conceituais para alguns indicadores do resultado de enfermagem Gravidade de Infecção da Nursing Outcomes Classification (NOC) relacionados aos problemas respiratórios, a partir de evidências científicas sobre sinais e sintomas de infecção em pessoas adultas. Métodos. Revisão integrativa da literatura com busca nas bases de dados PubMed, CINAHL, LILACS e SCOPUS. Foram incluídos estudos com textos na integra, publicados em espanhol, português ou inglês, usando os descritores gravidade da infecção, classificação dos resultados de enfermagem da NOC, infecções respiratórias, e sinais e sintomas respiratórios. Resultados. Analisaram-se nove publicações que embasaram a elaboração das definições conceituais de oitos indicadores do Resultado de Enfermagem Gravidade de Infecção: expectoração purulenta, febre, hipotermia, instabilidade da temperatura, dor, colonização em cultura de expectoração, elevação na contagem das células brancas e depressão na contagem das células brancas. Conclusão. O estudo contribuiu para a compreensão dos termos utilizados no resultado enfermagem Gravidade de Infecção, de modo a aperfeiçoar e facilitar o uso da NOC, à medida que apresenta refinamento do ponto de vista conceitual dos indicadores selecionados, de modo a produzir melhores evidências científicas.