Accuracy of the defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns

OBJECTIVE

To identify the measures of accuracy for defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns.

METHOD

Diagnostic accuracy study with cross-sectional design performed in medium and high-risk maternity units, located in Fortaleza city/Brazil. A total of 216 newborns were evaluated to identify the defining characteristics of the diagnosis under study. The measures of accuracy for defining characteristics were obtained from a latent class model with random effects for the calculation of sensitivity and specificity values.

RESULTS

The characteristics of increased respiratory rate and warm skin to the touch had higher sensitivity values (99.9%) and lower specificity (79 and 75%) and the characteristics of body temperature fluctuations above and below the normal parameters and hypertension had the highest specificity (80.4 and 100%, respectively).

CONCLUSION

The characteristic fluctuation of the body temperature above and below the normal parameters may be better to confirm the diagnosis, having presented a higher specificity value.

Associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery

OBJECTIVE

To determine associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery.

METHOD

Cross sectional quantitative study. Participants were 312 adult patients within the first 48 hours after thoracic or upper abdominal surgery. Patients were examined by the research team using an instrument with variables related to the respiratory function. The research team established the presence/absence of three nursing diagnoses and proposed interventions using the NANDA-I classification and the Nursing Interventions Classification. Correlations were tested using the chi-square or Fisher's test.

RESULTS

From the total 312 examinations, ineffective airway clearance was present in 185 (59.3%) assessments, ineffective breathing pattern in 123 (39.4%), and impaired gas exchange in 141 (45.4%). Significant correlations showed that patients with ineffective airway clearance were more likely to require pain management (or: 2.27), chest physiotherapy (or: 2.96), and positioning (or:1.8), while patients with impaired gas exchange were less likely to require airway management (or: 0.13) and chest physiotherapy (or: 0.28).

CONCLUSIONS

Patients with ineffective airway clearance had more chances of requiring pain management, chest physiotherapy, and positioning, while the nursing diagnosis impaired gas exchange was related with airway management and chest physiotherapy. The findings provide basis for nurses to develop effective care plans and to minimize postoperative respiratory complications.

The connection between nursing diagnosis and the use of healthcare resources

AIM

The health service invests up to 75% of its resources on chronic care where the focus should be on caring rather than curing. Nursing staff focuses their work on such care. Care requires being redorded in health histories through the standardized languages. These records enable useful analyses to organisational and healthcare decision-making. Our proposal is to know the association of between nursing diagnosis and a higher total expenditure on health.

METHOD

An observational cross-sectional analytical study was performed based on data from electronic health records in Primary Care (Drago-AP), hospital discharges (CMBD-AH) and prescriptions (REC-SCS) of patients over 50 from 2012-2013 in the Canary Islands. A descriptive, bivariate and multivariate analysis was undertaken to create a predictive model on the use of resources.

INDEPENDENT VARIABLES

Sociodemographic (age, sex, type of health-care affiliation, type of prescription charge) and nursing diagnosis (ND) recorded in late 2012. Dependent variables: Resources consumed in 2013.

RESULTS

582,171 patients met the criteria for inclusion. 53.0% of them were women with an average age of 64.3 years (SD 10.8years). 53.2% were pensioners. 49% of the included population had an ND, with an average of 2.1ND per patient. The average costs per patient were 1824.62€ (with a median of 827.5€) 25 and 27 percentiles of 264.1€ and 1824.7€, respectively. The bivariate analysis showed a significant correlation between these expenses and all the demographic variables; the expenses increased when a nursing diagnosis has been made (Spearman's rank=0.37: the more diagnoses, the more expenses). In the multivariate analysis, a first linear regression with the sociodemographic variables as independent variables explains 13.7% of the variability of the logarithm of the full costs (R²=0.137). If we add to this model the presence of nursing diagnoses, the explanatory capacity reaches 19.77% (R²=0.1977).

CONCLUSION

Compared with a model that only consists of sociodemographic variables, nursing diagnoses can enhance the explanatory capacity of the use of healthcare resources.

[Community resources prescription for self-care improvement in chronic illnesses. Clinical case management in Primary Health Care]

A case is presented of a 52 year-old male seen in a Primary Care nursing clinic for a type 2 diabetes mellitus metabolic control. The frequency of the visits increased due to perceived difficulties caused by changing the medical treatment. A focused interview was conducted under functional health patterns framework. The patient was unable to write or read, had not worked for the last 25 years, and expressed a lack of control over his self-care. An action plan was prepared, prioritizing Ineffective Health Maintenance, Powerlessness, and Impaired Social Interaction NANDA-I nursing diagnoses. The goals were set at improving knowledge and control over his disease and participating in leisure activities. To achieve these, the social health resources in the area were contacted, and agreed that the patient could attend activities that could improve his self-care and his quality of life. An improvement in his diabetes control was observed in the following evaluations, with an increase in his level of knowledge and self-care. The Primary Health care nurse should consider available community resources by using a comprehensive approach to chronic diseases for their therapeutic benefit and management, especially in those patients with adverse sociocultural conditions.

[The heart failure patient: a case report]

Given its prevalence, high mortality rate, morbidity, chronicity and use of resources, heart failure (HF) is a priority issue from a social and health standpoint, due to the ageing population and to lack of adherence to and the complexity of treatment. For these reasons, an individualized care plan needs to be established to meet the real and potential needs of the patient diagnosed with HF. A clinical case is presented of a patient admitted to the Cardiology Critical Care (CCC) unit of a tertiary hospital. A patient care plan was prepared following the steps of the scientific method and relying on the NANDA taxonomy, and the NOC and NIC to design goals and nursing interventions, respectively.