A clinical pathway for congestive heart failure

This study has shown improved outcomes with the use of a clinical pathway. However, under PPS additional ways for coordination among healthcare providers and patients need to be developed to ensure improved care beyond those focusing on the use of the pathway. One recommendation is the use of telehealth.

Predictors of hospital readmission among the elderly with congestive heart failure

This study compared elderly patients with congestive heart failure discharged from home healthcare to the home vs. those rehospitalized. The rate of rehospitalization in this sample of 117 was 27%. Significant predictors of rehospitalization included number of home healthcare days, number of previous hospitalizations, and the services of a home health aide. Implications include the timing and nature of home health visits.

Taxonomic validation: an overview

A valid taxonomy legitimizes the elements that make up the taxonomy and increases trust in its generalizability and predictability. There is a concern that the NANDA Taxonomy is not a valid taxonomic structure. Despite on-going work to validate individual nursing diagnoses, there is little research that focuses on validation of groups of diagnoses (taxons) within the NANDA taxonomy. This last article in a series of four will familiarize the readers with why, what, and how a taxonomy of nursing diagnoses can be validated. This article highlights assessment of the validity and reliability of a taxonomy, compares the process of taxonomic validation to the research process, and explores examples of validation design.

Axes: focus of taxonomy II

A number of persistent issues in the nursing diagnosis community have challenged the ability of one nursing diagnosis taxonomy to account for nursing's practice. The North American Nursing Diagnosis Association (NANDA) Taxonomy Committee, charged with the preparation of one taxonomy for all, has struggled with some of these issues and has initiated development of axes. The issues, figuratively speaking, become the axes. The axes are intended to describe the dimensions of the human condition. This article, third in a series of four, describes the process and development of the proposed axes.

Development of definitions for taxonomy II

In the process of placing diagnoses into Taxonomy I, certain inconsistencies became apparent. Inadequate definition of both diagnoses and human response patterns, lack of defining characteristics, and inconsistency in the levels of abstraction within the taxonomic hierarchy made the task of assigning a diagnosis to a taxonomic pattern difficult. Ambiguity in the definitions of the nine patterns resulted in ambiguity in the basic foundation, which affected the entire structure. The Taxonomy Committee, before evaluating the current structure, had to make the following decisions regarding the current human response patterns: (1) Should the nine human response patterns be retained for further taxonomic work? and (2) If they are retained, what should be the first step in examining Taxonomy I-Revised? This second article in a series of four will familiarize the readers with the process and decisions by which Taxonomy II of the North American Nursing Diagnosis Association (NANDA) is evolving through the work of the Taxonomy Committee. This article also will identify the specific problems encountered in the development of Taxonomy I and Taxonomy I-Revised, and describe the steps establishing the validity of the process of formation of the nine human response patterns.

The development of NANDA's nursing diagnosis taxonomy

In the early 1970s the need for a precise and computerizable language of nursing phenomena was identified. This need stimulated the formation of the National Conference Group for the Classification of Nursing Diagnoses. The group began the work of identifying nursing diagnoses and developing a taxonomic structure for their classification. Based on the initial success with the development of nursing diagnoses, the conference group became the North American Nursing Diagnosis Association (NANDA). There are two benefits of taxonomic development within nursing: one is scientific in nature, while the other is applied or practical. The development of this taxonomy has occurred over a span of 17 years including nine national conferences. Details of this development have been abstracted from the proceedings of the nine conferences and the minutes of the Taxonomy Committee in order to explicate the taxonomic structure. The rules for the classification, developed by the committee, are presented. Future directions for taxonomic development and collaboration with other health care professions are proposed.

Nursing diagnosis in the chronically ill: methodology for clinical validation

The identification and validation of nursing diagnoses that describe the phenomena of concern to nursing is a critical task. Methodological issues revolving around the conceptualization of nursing and the research approach have hampered this effort. This study used the human needs framework as a guide for the assessment and formulation of nursing diagnoses. A two-phase study was conducted. In Phase 1 five judges derived 51 nursing diagnoses using data from direct clinical observations of 50 subjects. In Phase 2 data from a second sample of 108 subjects were compared to Phase 1 data via computer analysis. Fifty of the 51 diagnoses were confirmed.