International Journal of Nursing Knowledge最新文献

Aim: To evaluate the global impact of the NANDA-I, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) (NNN) standardized nursing terminologies on nursing care quality, consistency, and documentation.

Design: Systematic review of experimental and quasi-experimental studies conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered in PROSPERO (CRD42024564151).

Data sources: PubMed, Web of Science, and Scopus databases were searched for studies published between May 2019 and June 2024 using predefined Population, Intervention/Exposure, Control, and Outcomes-based keywords.

Review methods: A total of 783 articles were identified; a total of 32 met inclusion criteria after duplicate removal and full-text screening. Quality was assessed using validated tools, including The National Heart, Lung, and Blood Institute, Joanna Briggs Institute, and Mixed Method Assessment Tool checklists.

Results: The included studies, mostly from Latin America and Southern Europe, reported positive impacts of the NNN system on clinical reasoning, individualized care planning, documentation quality, and interdisciplinary communication. Barriers included insufficient training, system integration challenges, and limited uptake in regions like North Africa and Asia. Although diverse study designs were used, few evaluated long-term clinical or organizational outcomes.

Conclusion: NANDA-I, NIC, and NOC classifications enhance nursing practice by supporting structured care processes and measurable outcomes. Their global implementation remains uneven, highlighting the need for institutional support, educational integration, and region-specific implementation research.

Relevance to clinical practice: Integrating standardized nursing languages into clinical, educational, and policy frameworks can strengthen evidence-based care, improve documentation, and elevate the visibility of nursing contributions to patient outcomes.

Purpose: To clinically validate the nursing diagnosis "Inadequate Nutritional Intake" based on elements identified within a specific situation theory framework in the context of children with cancer.

Methods: This is a diagnostic accuracy study following the Standards for Reporting Diagnostic Accuracy Studies (STARD) protocol. Specifically, it refers to the clinical validation phase of the nursing diagnosis Inadequate nutritional intake, using a cross-sectional design. The study was conducted in a tertiary pediatric hospital with a sample of 69 children diagnosed with cancer.

Findings: A total of 11 clinical indicators demonstrated diagnostic accuracy above 50%, including: ascites, low weight-for-age ≤2 SD, cachexia, mid-upper arm circumference < 10th percentile, fatigue, pale mucous membranes, dry mucosa, dry skin, weight loss greater than 5% within 1 month, compromised immune response, and delayed wound healing. The primary etiological factors identified in this study were chemotherapy, economic disadvantage, inadequate dietary pattern, insufficient dietary intake, rejection of hospital food, and family food culture. The nursing diagnosis had a prevalence of 7.25% among the participating children.

Conclusions: Despite the low prevalence, this study highlights that inadequate nutritional intake is a real and complex health issue in this population, with multiple etiological factors requiring a precise and systematic assessment for early identification by healthcare professionals, particularly nurses. This underscores the importance of research focused on refining nursing diagnoses in specific populations.

Implications for nursing practice: Validation studies such as this enhance the accuracy and evidence-based nature of nursing practice, while also supporting collaborative decision-making for addressing nutritional issues in children with cancer, considering the various etiological factors involved.

Purpose: To evaluate the evidence of internal structure validity of the nursing outcome (NO) "Mechanical Ventilation Weaning Response: Adult (0412)" of the NOs classification for critically ill COVID-19 patients.

Methods: A methodological study focused on internal structural validation, part of a multicenter study, was carried out in the intensive care units of two hospitals in Brazil, from 2020 to 2021. Patients in critical condition due to COVID-19 subjected to mechanical ventilation for more than 24 h and with an invasive device attached to the ventilator in the final phase of the weaning process were evaluated. The researchers used an instrument containing sociodemographic and clinical data and a physical examination of the clinical conditions based on the indicators of the NO. An exploratory factor analysis was performed, using the Kaiser-Meyer-Olkin method, in addition to other additional adjustment indexes. Reliability was assessed using McDonald's omega, Cronbach's alpha, and Gutmann's lambda 6 coefficients.

Findings: Among the 20 indicators evaluated, 6 were included in the final structure organized into two factors, the first being composed of spontaneous respiratory rhythm, spontaneous respiratory depth, discomfort, and difficulty breathing on own, and the second of anxiety and fear. This two-dimensional structure explains about 62.9% of the total variance. The final structure showed good internal consistency, suggesting that the indicators were measuring the same construct.

Conclusions: The structure proposed for the NO was shown to be reliable and valid for practice and research to evaluate patients with COVID-19 in the final phase of ventilatory weaning.

Implications for nursing practice: The findings are expected to provide robust evidence for clinical nursing practice. The proposal to organize this NO into dimensions could facilitate the nurse's clinical reasoning and make the monitoring of indicators more organized and faster for the evaluation of patients in ventilatory weaning.

Aim: This study aimed to identify distinct nurse clusters based on personal and environmental factors influencing their approaches to nursing diagnosis (NDs).

Methods: A cross-sectional study was conducted with 444 nurses from two hospitals in Italy. Data were collected using validated tools: the Behavioral Beliefs Scale (BBS), Normative Beliefs Scale (NBS), Control Beliefs Scale (CBS), positions on nursing diagnosis, Intention Scale (INT), Behavior Scale, Practice Environment Scale of the Nursing Work Index, and Nurse Clinical Reasoning Scale. A cluster analysis was performed.

Results: The study analyzed 444 nurses, predominantly female (85.36%) with a mean age of 40.11 and 20.92 years of experience in nursing. Factor analysis confirmed the unidimensional structures for the BBS, NBS, and CBS scales, with excellent fit and reliability. Three clusters emerged: "positive beliefs" (37.4%), "neutral beliefs" (48.6%), and "negative beliefs" (14%). Nurses in the positive cluster exhibited stronger clinical reasoning skills and more favorable perceptions of the work environment. Significant differences were noted across clusters regarding practice environment subscales and behavioral beliefs.

Conclusions: Both personal and environmental factors significantly impact nurses' engagement with NDs. Tailored strategies to improve clinical reasoning and enhance work environments are essential to fostering positive attitudes and effective use of NDs.

Implications for nursing practice: By classifying nurses based on their beliefs regarding nursing diagnoses, administrators and educators can more effectively tailor interventions to improve the application of nursing diagnoses in practical environments.

Purpose: To estimate the diagnostic accuracy of nurse-performed lung ultrasound (LUS) for detecting pulmonary congestion in adults with acute kidney injury (AKI) and to relate ultrasound findings to the defining characteristics of the NANDA-I nursing diagnosis excess fluid volume.

Methods: In this prospective exploratory diagnostic accuracy study, conducted between October 2022 and September 2023, a critical care nurse performed bedside LUS, following the bedside lung ultrasound in emergency protocol, in a convenience sample of 64 intensive care unit patients with AKI in a general hospital in Brazil. Pulmonary congestion was defined as ≥3 B-lines in ≥2 intercostal spaces per hemithorax. The reference standard was radiological evidence of vascular congestion on chest radiograph or computed tomography interpreted by blinded intensivists. Sensitivity, specificity, positive and negative predictive values were calculated with 95% confidence intervals. Agreement between LUS and radiologic findings was assessed using Gwet's AC1 coefficient. The COVID-19 pandemic limited patient flow; therefore, no formal sample-size calculation was feasible. Results should be considered preliminary.

Findings: Pulmonary congestion was present in 14/64 patients (21.9%). LUS sensitivity was 50% (95% CI 23%-77%) and specificity 94 % (89%-99%). Positive and negative predictive values were 70% and 87%, respectively. Agreement between LUS and radiology was substantial (AC1 = 0.77, 0.63-0.92). No LUS-related adverse events occurred. Presence of ≥3 B-lines-an objective ultrasonographic marker of interstitial fluid-corresponded to the defining characteristic "pulmonary congestion" of NANDA-I diagnosis 00026.

Conclusions: A single well-trained nurse achieved high specificity using LUS to rule out pulmonary congestion in critically ill patients with AKI. Limited sensitivity and wide confidence intervals highlight the need for larger, multicenter studies with sufficient positive cases. Linking B-lines to the defining characteristic of Excess Fluid Volume supports integration of point-of-care ultrasound into nursing diagnostic reasoning.

Implications for nursing practice: Bedside nurse-performed LUS can strengthen clinical decision-making by quickly excluding pulmonary congestion-thereby informing volume-management interventions aligned with the NANDA-I taxonomy.

Background: Clinical indicators (CI) of the nursing diagnosis (ND) ineffective health maintenance behaviors (IHMB) (00292) may be present in women who do not wish to become pregnant. Thus, nurses should to be attentive of the individual, cultural, and social characteristics of these women in order to identify behaviors (CI) that may represent a risk for unwanted pregnancy.

Purpose: This study aimed to identify CI of IHMB in women of childbearing age who do not wish to become pregnant.

Design: Systematic review of diagnostic test accuracy.

Data sources: Scopus, PubMed/MEDLINE, Embase, Biblioteca Virtual em Saúde, PsycINFO (Searched on November 12, 2023) and Ovid, Web of Science, CINAHL, Google Scholar, and ProQuest (searched on June 10, 2024).

Data synthesis: The final sample resulted in five articles, in which two CI were identified in women who manifested the ND IHMB. "Ineffective choices in daily life for meeting health goals" was identified in women when they did not discuss contraceptive methods with their partners. "Failure to perceive health risk" was identified when women had low or no perception of pregnancy risk.

Conclusion: Two CI of IHMB were identified in women who do not wish to become pregnant: "ineffective choices in daily life for meeting health goals" and "failure to perceive health risk."

Implications for the profession and/or patient care: These findings will provide nurses a better understanding of behaviors expressed by women who do not wish to become pregnant that prevent them to use contraception, that way nurses can make specific interventions on these issues. Including the indicator failure to perceive health risk to the NANDA International can broaden the spectrum of nurse's assessment for the study population.

Purpose: To validate the content of the nursing intervention "0565 - ultrasonography: bladder."

Method: The content validation study was conducted from September to November 2022, with a sample of 22 specialists who evaluated the components of the nursing intervention "0565 - ultrasonography: bladder," according to the Nursing Interventions Classification, considering the pertinence, relevance, and clarity of the title, definition, and 17 activities of the intervention as well as education level and estimated time to perform. Data collection used an online form followed by a focus group. For analysis, the content validity index with a minimum agreement proportion of 85% was used. Items that did not achieve agreement through the online form were discussed in the focus group.

Results: Of the 21 items evaluated, 13 were validated in the first stage of the study. The remaining eight were evaluated in the focus group, modified, and consensually approved.

Conclusion: The nursing intervention "0565 - ultrasonography: bladder" had its content completely validated.

Implications for nursing practice: The validation of this intervention allows its application in clinical practice with standardized nursing languages that give visibility to the profession, highlighting the use of technology in the patient care process and promoting evidence-based practice.

Purpose: To develop an integrated nursing educational theory using Walker and Avant's theoretical synthesis methodology.

Data sources: Watson's Theory of Human Caring, Mezirow's Transformative Learning Theory, and nursing literature related to undergraduate nursing students' perceptions of caring.

Data synthesis: Key concepts from these theories were synthesized in the formation of the transformative caring theory.

Conclusions: The transformative caring theory provides a framework for nurse educators to foster nursing students' development of caring behaviors and caring competencies through emancipatory and transformative education.

Implications for nursing practice: To assist undergraduate students to gain an understanding of the importance of developing new caring meaning perspectives and caring attributes in their becoming contemporary, caring, compassionate professional nurses. Harnessed with this knowledge, students can become empowered as patient advocates through humanistic, emancipatory, and relational caring praxis to potentiate health, reduce human suffering, and address issues of social injustices and health inequities.