International Journal of Nursing Knowledge最新文献

Purpose: To verify the association of the nursing diagnosis (ND) Ineffective Health Self-Management (IHS) (00276) with severe radiodermatitis in individuals with anal and/or rectal canal cancer.

Methods: Cohort study, secondary to a clinical trial. Data were extracted from 57 participants undergoing radiotherapy (RT) for anal and/or rectal cancer so that a panel of experts could assess the presence of the defined characteristics and the ND of IHS. Descriptive and inferential statistical analysis was performed. Univariate analyses and bivariate analyses were applied using Fisher's exact test and chi-square test.

Findings: The ND had a high prevalence. There was an association among participants with three or more defining characteristics (DC) of that diagnosis in patients experiencing severe radiodermatitis.

Conclusions: An association was identified between the presence of three or more DC in the onset of severe radiodermatitis in individuals with anal and/or rectal canal cancer.

Implications for nursing practice: The study contributes to incorporating the association between a human response and an adverse event in the nursing standards or guidelines related to the context of RT.

Purpose: To identify a consensus-based subset of NANDA-I nursing diagnoses (NDs) specifically relevant to mental health and addiction care, facilitating their integration into clinical practice and electronic health records (EHRs).

Methods: A multiphase e-Delphi study was realized engaging 33 international nurses with experience in the fields of interest and in standardized nursing languages. Participants evaluated the relevance of 267 NANDA-I NDs (12th edition) using a 9-point scoring system, allowing for the immediate inclusion of 130 NDs with high consensus (median scores of 7-9). Further five uncertain NDs were included after undergoing a second Delphi round.

Findings: A total of 135 NDs (50.6% of NANDA-I taxonomy) were identified as essential for mental health and addiction care. Domains such as self-perception, coping/stress tolerance, and interpersonal relationships had the highest inclusion rates, reflecting the psychosocial and cognitive complexity of care in these settings. Conversely, NDs belonging to domains like growth/development, safety/protection, and elimination/exchange were selected in a more focused way, limiting to conditions reflecting expected side effects of psychiatric medications or substance misuse or risks for other- or self-directed injuries.

Conclusions: The identified subset of NDs seems to have the potential to capture the multifaceted nature of mental health and addiction nursing. This targeted approach addresses the unique needs of these populations and highlights nursing's critical role in holistic care delivery.

Implications for nursing practice: Implementing this NDs subset into EHRs can streamline clinical reasoning, enhance interdisciplinary communication, and align interventions with patient needs. By focusing on a refined set of diagnoses, nurses can improve care quality, optimize outcomes, and contribute to evidence-based decision making in mental health and addiction care. Future research should evaluate the subset's impact on patient outcomes and healthcare efficiency.

Aim: This review identifies technologies used to teach Standardized Nursing Languages and their impact on nursing students' educational outcomes.

Methods: A literature review, updated to June 14, 2024, was conducted by consulting the PubMed, CINAHL, Scopus, and Cochrane databases. The main inclusion criterion was primary studies in which technology was used to educate students on Standardized Nursing Languages.

Results: Three types of technology were addressed: Computerized Aids and Electronic Devices, Decision Support Systems, and Diagnostic Reasoning Software. Most of these technologies were found to positively impact knowledge, performance, application of the nursing process, diagnostic accuracy, and clinical reasoning.

Conclusions and implications for nursing education: Integrating technology into nursing education enhances nursing students' skills and equips them to handle the digital aspects of modern health care. Technologies must support all stages of the nursing process, reinforce clinical reasoning, and offer timely feedback. Additionally, the presence of teachers during technology training is crucial to ensure proper functioning, provide technical support, manage the learning environment, and verify students' skills. Nursing students with technological skills will become nurses capable of producing complete and quality clinical documentation and supporting their professional achievements.

Purpose: To determine the accuracy of nursing diagnoses at hospital admission and discharge for patients with heart failure (HF).

Methods: This comparative study examined the documentation in 155 medical records of patients with an admitting diagnosis of HF during August 2018 and July 2019. An audit tool was used to record the diagnoses made by nurses during routine care at the time of admission and discharge. Two researchers (L.S. and A.C.) examined the records and evaluated the documented nursing diagnoses using the Nursing Diagnosis Accuracy Scale version 2. Kappa was used for agreement between them. Patient social and clinical characteristics were described using percentages, absolute frequencies, means, and standard deviations.

Findings: A total of 18 unique nursing diagnoses were identified across the 155 patients. Among the 754 nursing diagnoses recorded, 85% of those identified at admission (n = 644) were deemed highly accurate. At discharge, of the 527 diagnoses recorded, 66% (n = 349) were rated as highly accurate. Excess fluid volume was the most common diagnosis (85% at admission, 49% at discharge). Three risk diagnoses were frequent at both points: risk for infection, risk for falls, and risk for decreased cardiac output. Agreement between evaluators ranged from Κ = 0.234 to 1.00.

Conclusions: Greater agreement in nursing diagnoses at discharge likely reflects ongoing patient monitoring. Persistent diagnoses at discharge highlight the need for continued nursing care post-discharge.

Implications for nursing practice: This study encourages nurses to improve clinical evaluation for HF patients from admission to discharge. As key clinical indicators are identified, nurses can improve the accuracy of their diagnoses and plan more effective interventions to achieve positive health outcomes and reduce unnecessary hospitalization.

Objective: The objective of study was to present evidence of the content validity of conceptual and operational definitions of the "Blood Transfusion Reaction (code 0700)" nursing outcome from the Nursing Outcomes Classification (NOC).

Method: A methodological study was implemented in four phases. The first phase consisted of a narrative literature review in which the main indicators related to blood transfusion were identified: 25 new indicators that were not present in NOC, in addition to 14 existing indicators, for a total of 39 to be studied. In the second phase, conceptual and operational definitions, and magnitude of NOC indicators were developed. The third phase consisted of analysis of evidence of content validity of conceptual and operational definitions of indicators, through assessment by experts. In the fourth phase, a pilot test was applied to 40 electronic medical records of patients who received blood components and presented with a transfusion reaction.

Results: A total of 27 articles were analyzed and served as support to develop conceptual and operational definitions, and magnitude of indicators, considered for the outcome under study. It was assessed by a group of 10 experts, requiring three rounds to reach the established critical content validity ratio in which four of these indicators were excluded, leaving 35 indicators in the final version. A pilot test on 40 records revealed the presence of 13 indicators, of which six were present in the classification.

Conclusion: The conceptual and operational definitions and magnitude developed for the "Blood Transfusion Reaction (code 0700)" nursing outcome demonstrated adequate evidence of content validity in the 21 indicators found in the literature, along with 14 indicators already present in NOC, and 13 of these indicators were present in patients receiving blood components who presented a transfusion reaction.

Implications for practice: Nurses can use this nursing outcome as a clinical assessment tool for monitoring blood transfusion recipients' clinical signs.

Objective: To evaluate the accuracy of the defining characteristics of the nursing diagnosis Impaired skin integrity (00046) in patients admitted to intensive care units (ICUs).

Methods: A cross-sectional diagnostic accuracy study was conducted with 105 adult patients admitted to an ICU. A latent class model with random effects was used to test the sensitivity and specificity of the defining characteristics investigated. The diagnosis Impaired skin integrity (00046) was the dependent variable, whereas sociodemographic and clinical data were the independent variables.

Results: Impaired skin integrity was present in 3.75% of the sample. The defining characteristic with the best accuracy for the diagnosis was dry skin, with high sensitivity (0.9994) and specificity (0.9106). Other characteristics stood out in terms of sensitivity measures: altered skin color (0.9994) and foreign matter piercing skin (0.9994). In terms of specificity, the following stood out: desquamation (1.000), localized area hot to touch (0.9901), pruritus (0.9897), bleeding (0.9802), and hematoma (0.9208).

Conclusion: The defining characteristics that helped infer the diagnosis Impaired skin integrity (00046) with greater certainty were dry skin, altered skin color, foreign matter piercing skin, desquamation, localized area hot to touch, pruritus, bleeding, and hematoma.

Implications for nursing practice: Identifying defining characteristics with high diagnostic accuracy for Impaired skin integrity (00046) enables nurses to expand their clinical perspective on this dysfunction, which can affect the skin of critically ill patients, and to develop individualized care plans.

Objective: To clinically validate the nursing diagnosis (ND) inadequate social support network in breastfeeding mothers.

Method: This cross-sectional quantitative study employed clinical indicator accuracy analysis and hierarchical modeling for the etiological factors of the ND inadequate social support network. The study included 285 breastfeeding mothers registered in primary healthcare units.

Results: The most prevalent clinical indicators within the sample were deficit in instrumental support from health services, imposition of appropriate behaviors, weak social bonds, and negative social interactions. The most frequent etiological factors were deficit in strong bonds, fragility of institutional network organization, unwillingness to provide support, refusal to provide support, and deficit in healthcare professionals.

Conclusion: The ND inadequate social support network was clinically validated within the population of breastfeeding mothers, resulting in six clinical indicators with high sensitivity and specificity for identifying the diagnosis. Additionally, the statistical analysis of the etiological factors identified seven antecedents to the emergence of the diagnosis.

Implications for nursing practice: Based on these findings, nurses can better assist breastfeeding mothers with the aim of preventing an inadequate social support network. By identifying this phenomenon, it becomes possible to plan care and implement nursing interventions to address this issue effectively.

Purpose: To quantitatively pool the overall prevalence of self-neglect in older adults and provide evidence-based information for healthcare professionals to develop preventive measures.

Methods: Systematically and thoroughly searched ten databases from inception to September 1, 2024 and we pooled the prevalence of self-neglect in older adults using a random-effects model based on the Stata 15.0 software.

Results: In our meta-analysis, 21 studies were included, and the estimated prevalence rate of self-neglect among older adults was 27% (95% CI: 23%-30%). We found that the incidence of self-neglect was higher in males, aged 80 years, developing countries, hospitals, and using the Elder Self-Neglect Questionnaire assessment tool.

Conclusion: Self-neglect is a common and underestimated phenomenon in older adults, and the prevalence rate of self-neglect is high. Several epidemiological characteristics such as gender, age, countries, settings, and definition criteria were associated with its prevalence. It deserves early screening and targeted intervention by using a globally accepted definition of self-neglect to prevent older adults from self-neglect.

Implications for nursing practice: Our study can provide clinical evidence for nursing staff and healthcare professionals to identify high-risk groups of self-neglect in older adults.

Purpose: This purpose of this article was to use the method of conceptual history to analyze the evolution of the concept of "validity" in nursing diagnoses and to identify key transformations, theoretical influences, and implications for contemporary clinical judgment and decision-making.

Methods: Five stages derivate from the approach proposed by Reinhart Koselleck, including: identify the concept and its relevance, historical contextualization, contextual use, semantic changes over time, and synthesis and interpretation.

Findings: The concept of "validity" in nursing diagnoses is essential for accurate diagnostics, interdisciplinary communication, and evidence-based decision-making, though its interpretation varies due to differing philosophical perspectives and methodological challenges. Historically, "validity" in nursing evolved from empirical methods to theory-driven approaches incorporating psychometric and clinical frameworks. Validation processes have adapted, integrating scientific rigor, ethical considerations, and practical utility, while also reflecting societal, technological, and cultural shifts. Today, the focus is on balancing methodological diversity and evidence-based practice, with a need for continuous quality improvement, interdisciplinary collaboration, cultural sensitivity, and patient involvement.

Conclusions: The concept of "validity" in nursing diagnoses has evolved from early empirical methods to its current focus on evidence-based practices, interdisciplinary integration, and cultural sensitivity, emphasizing the need for accurate, technologically informed diagnostics to enhance patient care and guide clinical decision-making.

Implications for nursing practice: Nursing must integrate diverse perspectives, cultural sensitivity, and technology into its diagnoses, and professionals should be trained in both scientific and ethical aspects to improve patient outcomes.