International Journal of Nursing Knowledge最新文献

Purpose: To analyze the prevalence, accuracy of clinical indicators and related factors of the nursing diagnosis of ineffective breathing pattern (00032) in patients hospitalized due to COVID-19.

Methods: This is a cross-sectional study conducted in a public hospital, involving 250 adult hospitalizations between 2020 and 2021. Data were collected retrospectively from electronic medical records. Latent class analysis and multivariate logistic regression were performed to analyze the nursing diagnosis of ineffective breathing pattern.

Findings: The prevalence of the ineffective breathing pattern diagnosis was 62%. The main clinical indicators identified included tachypnea, use of accessory muscles for breathing, abdominal paradoxical breathing pattern, and hypoxemia. Latent class analysis indicated that the three-class model was the most suitable, with Class 3 showing the highest prevalence. Indicators such as tachypnea and use of accessory muscles demonstrated high sensitivity, while hypoxemia exhibited high specificity. The presence of fatigue, pain, body position that inhibits lung expansion, and obesity significantly increased the likelihood of the ineffective breathing pattern diagnosis.

Conclusions: The diagnosis of ineffective breathing pattern is prevalent in patients hospitalized with COVID-19, with precise clinical indicators. Fatigue, pain, inadequate body position, and obesity were associated factors.

Implications for nursing practice: The clinical validation of the ineffective breathing pattern diagnosis in the population of individuals infected with SARS-CoV-2 is essential for improving the level of evidence. Additionally, it contributes to the nurse's diagnostic inference in clinical practice and decision making for appropriate treatment.

Objectives: This study aimed to analyze evidence of content validity of the related factors (RFs) of the nursing diagnosis (ND) "ineffective health self-management" in people living with the human immunodeficiency virus (HIV).

Methods: It is a methodological study carried out between April/2022 and May/2023 in three stages: scoping review aimed at the RFs of the ND "ineffective health self-management" for people living with HIV (PLHIV); elaboration of conceptual definitions (CDs) and operational definitions (ODs) of the RFs and proposition of new RFs for the ND studied; and content validation of the constructed definitions of the RFs. A sample of 31 expert nurses was selected for content validation. A binomial test was used, with a significance level of 5%, p < 0.05, and a percentage of 85% in the attribution of definitions considered adequate. The content validity index (CVI) was calculated, and when ≥ 0.80, they were considered relevant.

Results: Three new RFs were proposed as components of the diagnosis, adding to the 30 already included in the NANDA-I version (2021-2023). Expert nurses analyzed these components, and all 33 RFs were considered adequate (>85%). All 33 CDs and 33 ODs were validated with CVI ≥ 0.80.

Conclusions: In addition to constructing and validating definitions for the 30 existing RFs, this study identified and validated three new proposed RFs of the diagnosis "ineffective health self-management": (1) unrealistic perception of vulnerability to other diseases and health problems; (2) chemical dependency and escape from reality; and (3) lack of structuring of health services and inefficiency of public policies for PLHIV.

Implications for nursing: The content analysis of the diagnosis "ineffective health self-management" contributes to nursing as a science and provides specific knowledge for building the care plan, in addition to bringing professionals closer to the specific terminologies of the profession.

Purpose: To investigate the factors influencing the completion quality of nursing documentation (NDoc) in Romania using multilevel modeling.

Design: Retrospective descriptive study.

Methods: A mixed-effect logistic regression analysis was conducted to identify factors affecting the completion of NDoc by using the Q-DIO instrument. A total of 395 NDocs were selected by probabilistic sampling.

Findings: The study identified significant correlations among the Q-DIO sub-concepts. Specifically, "Nursing Diagnoses as Process" was significantly correlated with both "Nursing Diagnoses as Product" and "Nursing-Sensitive Patient Outcomes." Additionally, "Nursing Diagnoses as Product" is correlated with "Nursing Interventions." Among the external factors, the number of nurses involved in documentation was significantly linked to the completeness of both "Nursing Diagnoses as Product" and "Nursing Interventions." Documentation quality also varied by hospital specialty, whereas the length of stay did not show any significant correlation with the Q-DIO sub-concepts.

Conclusions: The relationships between Q-DIO sub-concepts underscore the importance of addressing every phase of the nursing process for meaningful nursing-sensitive patient outcomes. External factors significantly affect documentation completion, requiring the consideration of organizational aspects when implementing NDoc.

Implications for nursing practice: This study highlights the need for nurses to systematically collect and document data across all phases of the nursing process. Training and support should be provided to improve the accuracy and completeness of nursing diagnoses and their linkage to interventions and outcomes. Additionally, organizational factors, such as staffing levels and the type of hospital specialty, should be carefully considered when implementing documentation innovations, as they significantly impact the quality and completeness of NDoc.

Background: Family engagement is crucial for achieving successful outcomes for both patients and hospitals. It supports safe transitions between care settings, providers, and ultimately, as illness progresses. However, in the hospital setting, family engagement is poorly operationalized. While the existing literature acknowledges its benefits, it does not adequately define the specific domains of family engagement, the roles families play during inpatient care, or whether these factors differ across patient populations.

Aims: This research aims to describe family engagement in the hospital setting and examine whether differences exist in documentation across various populations.

Methods: A retrospective chart review (RCR) was conducted using data extracted from the electronic medical records (EMRs) of adult patients admitted to neuroscience units at an academic medical center. Descriptive statistics were calculated for continuous and categorical variables. Chi-square analysis was performed on categorical variables (e.g., race, social deprivation index [SDI], cognitive impairment) to identify statistically significant differences between groups, with a threshold of p < 0.05.

Findings: The RCR included data of 293 patient records. The results reveal what is documented regarding family engagement in the EMR, who is documenting it, and where it is recorded. No differences were found in the documentation of engagement domains between Black and White patients, between patients with high and low SDI, or between patients with cognitive impairment and those without. However, differences were observed in documentation related to discharge placement.

Conclusion: These results have implications for further research, policy development, and provider education. They underscore the need for a structured template in the EMR and suggest potential implications for nursing diagnoses and interventions to better support family engagement in the hospital setting.

Purpose: This scoping review aimed to characterize content validity studies in nursing diagnostics, focusing on methodological approaches, including expert selection criteria, aggregation measures, and validation outcomes.

Method: A comprehensive literature review was conducted, encompassing studies published between 1989 and 2023. The primary sources included 78 articles from 22 different journals, with a significant number from Brazil and the United States.

Findings: The analysis revealed a concentration of content validity studies in a few countries, with Brazil and the United States leading. There was a noticeable shift in research focus from North America to Latin America and Europe over the past decade. Methodologically, the studies predominantly used Fehring's method, though recent works have adopted diverse approaches to improve study quality. Despite the expansion of the NANDA-I classification into various languages, research dissemination remains limited by regional publication preferences and the challenges of finding adequately experienced experts.

Conclusions: Content validity research in nursing diagnoses shows geographic and methodological disparities. While traditional methods remain prevalent, newer approaches are emerging, contributing to higher methodological rigor. However, publication in specialized and high-impact journals remains limited, affecting the global dissemination and implementation of findings.

Implications for nursing practice: This study underscores the importance of adopting diverse research methodologies and enhancing international collaboration to improve the validity and applicability of nursing diagnoses. Broadening publication strategies can facilitate the global exchange of knowledge and contribute to the standardization and refinement of nursing practices, ultimately improving patient care outcomes.

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.

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.