International Journal of Nursing Knowledge最新文献

Objective

To identify the most relevant clinical characteristics of the nursing diagnosis frail elderly syndrome (FES) in hospitalized patients aged 65 or older and analyze their impact on 9-month mortality and hospital readmission.

Methods

A prospective and prognostic accuracy study was conducted in patients aged 65 or older, who were admitted to hospital more than 24 h. A consecutive convenience sampling process was used. Assessment included defining characteristics (DCs) of FES, clinical fraility scale (CFS), frail scale (FS), and 9-month mortality and hospital readmission. Statistical tests were used to verify associations between variables. Binary logistic regression analysis and area under the curve were used, to identify significant predictors for the outcomes and evaluate the prognostic accuracy of the DCs.

Findings

This study involved 150 patients. CFS scored 65 patients (43.3%, confidence interval 95% 35.2% a 51.6) as frail and proved a prognostic value of mortality at 9 month from pre-frail state (p = 0.020). The mean number of DCs for FES nursing diagnosis was 6.35 (SD = 3.14). Validated tools for measuring frailty were associated with all DCs, excepting nutritional imbalance: below body needs. The hospital readmission during the following 9 months was only statistically related to memory impairment (p = 0.07).

Conclusion

Clinical frailty scale showed good results as a predictor of mortality. The study suggests exploring including it, in clinical manifestations of elderly frail syndrome. This study found that only memory impairment defining characteristic was predictive of hospital readmission. Further research should identify other relevant and prognostic clinical manifestations.

Implication for nursing practice

These findings highlight the importance of being vigilant on cognitive decline during hospital admissions. The most prevalent and determinant DCs identified in this study indicate that clinical should focus on preserving functional and mental abilities as well as mobility.

Purpose

To assess the quality of the nursing process in Romania by evaluating nursing documentations with the quality of diagnoses, interventions and outcomes (Q-DIO) measurement instrument.

Methods

A quantitative cross-sectional research design was employed using probabilistic sampling to select nursing documentations from a Romanian university hospital. The data were analyzed using the Q-DIO measurement instrument.

Findings

Low quality levels of nursing process documentation were found. The Q-DIO subscale “Nursing diagnoses as process” (assessment) revealed a mean = 1.36 (SD 0.52) of maximum 2. Nurses collected lots of data but did not use these to state nursing diagnoses. “Nursing diagnoses as product” showed inaccurate diagnoses; mean = 1.24 (SD 0.48) of maximum 4. Nursing interventions were planned and documented, but their impact on the etiology of nursing diagnoses was low; mean = 0.76 (SD 0.18). The quality of nursing outcomes mean was 0.57 (SD 0.29).

Nurses failed making connections between nursing assessment, diagnoses, interventions, and outcomes, and standardized nursing languages (SNLs) were not used. Statistically significant differences were found among all Q-DIO sub-concepts except for “Nursing diagnoses as process.”

Conclusions

The documentation was structured but did not support the nursing process and its documentation, and SNLs were not implemented. There was an underutilization of data to state nursing diagnoses, and nursing interventions were mostly ineffective, leading to low nursing outcomes.

Implications for nursing practice

This study provides new insights on the nursing process and its documentation in Romania and a baseline for future research. Policymakers, administrators, and educators should consider educating nurses to use standardized nursing languages and apply the Advanced Nursing Process.

Purpose

To evaluate the reduction of patients’ bed rest time after percutaneous renal biopsy (PRB) from 24 to 8 h using the Nursing Outcomes Classification (NOC).

Methods

This was a randomized clinical trial registered with Clinical Trials number NCT04629235. The sample comprised 16 patients in the intervention group and 18 in the control group. In the intervention group, the rest time was modified to 8 h, and afterward, the patients were released to ambulate, whereas the control patients remained at absolute rest for 24 h after PRB according to institutional protocol. All patients were observed for 24 h and evaluated at five time points with the outcomes and indicators of the NOC: before the biopsy, immediately after, at the 8th hour, at the 12th hour, and at the 24th hour after the procedure.

Results

In the 170 evaluations performed, statistically significant differences were identified in the outcome Comfort status: physical and the indicators “physical well-being and comfortable position.” None of the complications were related to reduced bed rest time.

Conclusions

Reducing patients’ bed rest time from 24 to 8 h did not increase complications from PRB, and using the NOC provided a standardized and reliable assessment.

Implications for nursing practice

Important evidence was identified for patient care after PRB, demonstrating the positive impact on patient comfort and the possibility of reducing costs to the institution and the workload of the multidisciplinary team. In addition, these findings may contribute to strengthening the use of NOC in clinical practice, teaching, and research.

Purpose

To determine the trajectories of spiritual distress and religious involvement among cancer patients during chemotherapy.

Methods

A prospective longitudinal study was conducted over 15 months with quarterly data collection, in a total of with five cut points. Data collection was applied a questionnaire that embraced sociodemographic characteristics, clinical profile, Spiritual Distress Scale, and Belief into Action Scale. Regarding, data analysis was performed univariate, bivariate, and multivariate statistics, and the study was approved by the Ethics Committee.

Findings

From the 322 cancer patients at the beginning, the attrition rate was 17.5% in the last time point. Most of participants were women (56.6%), with an average age of 60.3 years, and had a religious affiliation (93.7%). Statistically significant values were found of spiritual distress and religious involvement across the five cuts. At the end of 3 months after starting chemotherapy, the highest value of spiritual distress and the lowest value of religious involvement were reached.

Conclusions

Cancer patients who are submitted to chemotherapy, after 3 months of treatment experience the peak of spiritual distress and the lowest value of religious involvement. This critical period for nurses’ is required a massive approach regarding spiritual and religious needs.

Implications for nursing practice

Therefore, knowing the trajectories of spiritual distress and religious involvement during a certain period allows for the anticipating of planning of nursing therapeutic interventions in order to promote spiritual health and spiritual well-being outcomes in cancer patients.

Purpose

To obtain evidence of the clinical validity of the nursing diagnosis (ND) risk for disturbed maternal–fetal dyad in high-risk pregnancy.

Method

Causal validation of the ND through a case–control study performed in a university hospital with 155 high-risk pregnant women: 31 cases and 124 controls. A causal association was found between the ND etiological factors and the occurrence of disruption of the symbiotic maternal–fetal dyad; an association was verified when the etiological factor presented a p-value <0.05 and odds ratio >1.

Findings

The risk factor absent–inadequate prenatal care; populations at risk, such as young-advanced maternal age and economically disadvantaged pregnant women; and association conditions, such as maternal conditions and compromised fetal oxygen transport, increased the outcome likelihood. The associated condition maternal illnesses appeared as a protective factor.

Conclusions

Evidence of clinical validity of the ND risk for disturbed maternal–fetal dyad was obtained, and an association between etiological factors and disruption of the symbiotic maternal–fetal dyad was found.

Implications for nursing practice

The results contribute to advance scientific knowledge in nursing teaching, research, and practice and support the nursing process in high-risk pregnancies.

Purpose

The aim of this study is to design and validate the content of an instrument based on the Nursing Outcomes Classification (NOC) “Knowledge: disease process” and “Risk control: hypertension” to measure pregnant women's knowledge and self-care behaviors about hypertensive disorders.

Methods

The study was carried out in three phases: (a) content validity of the indicators, (b) construction, and (c) content validity of the instrument.

Findings

The instrument contains 72 items with an average content validity ratio and representativeness of 0.92. The items that did not reach the established values were eliminated or reformulated according to the observations made by the experts.

Conclusions

This study provides the first instrument for perinatal maternal care designed from the NOC that has demonstrated adequate content validity and representativeness of the NOCs on which it is based. The next phase in the development of the instrument is to test its validity and reliability.

Implications for nursing practice

CoNOCiTHE is a tool that can be useful in assessing pregnant women's knowledge and self-care behaviors about hypertensive disorders, contributing to the documentation and quality of maternal perinatal nursing care.

Purpose

To describe the current application status of NANDA-I nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) in cardiac rehabilitation nursing and identify useful NANDA-I, NIC, and NOC (NNN) linkages for clinical nursing practitioners.

Methods

This scoping review was performed in accordance with the Joanna Briggs Institut guidelines. We systematically searched eight databases, and the literature search took place between June and July 2023. The characteristics and results of the studies were synthesized and analyzed in a narrative way.

Findings

The application of NANDA-I nursing diagnosis, NIC and NOC in cardiac rehabilitation nursing can be divided into three topics: the content, value and effect of NANDA-I nursing diagnosis, NIC and NOC.

Conclusion

The application of NANDA-I, NIC, and NOC in the field of cardiac rehabilitation nursing shows positive effects on the whole, which can provide more standardized theoretical guidance, improve nursing outcomes in clinical settings, and enhance nursing quality.

Implications for nursing practice

This experience report will guide nurses to use NANDA-I, NIC, and NOC for better cardiac rehabilitation care.

Purpose

To develop a nursing diagnosis proposal derived from the concept of “disuse syndrome” based on an integrative review.

Methods

The conceptual derivation technique, proposed by Walker and Avant, was used in the following phases: an integrative review of the literature was carried out, applying the parameters of Whitermore and Knalf, where 43 articles were selected that covered the existence of the concept in the nursing discipline and other health sciences, the concepts were subsequently analyzed, and the new concept was redefined following the middle-range theory of causality and validation of nursing diagnoses proposed by Oliveira-Lopes et al.

Findings

The proposal of the new nursing diagnosis was developed, including the following elements: diagnostic label adult disuse syndrome, the corresponding definition, 25 defining characteristics, eight related factors, eight risk populations, and 14 associated problems.

Conclusions

The concept of the proposed new diagnosis describes adult disuse syndrome as a phenomenon that transcends the physiological component and should be viewed from a multidimensional view, expressing a clinical judgment related to a series of nursing diagnoses that appear together.

Implications for nursing practice

The results of this study will help nursing professionals to identify the phenomenon of adult disuse syndrome in any setting and in turn guide optimal care interventions that decrease the consequences of adult disuse syndrome.

This brief report discusses the implementation and evolution of suicide prevention strategies at Taoyuan Psychiatric Center in Taiwan. These strategies are inspired by the nursing interventions presented in an “Umbrella review of nursing interventions NIC for the treatment and prevention of suicidal behavior.” The interventions are a part of an employee assistance program (EAP) designed to support the mental health of the nursing staff and other employees, with a particular focus on preventing and managing suicidal behaviors. The EAP involves multi-tiered primary, secondary, and tertiary prevention measures, offering different levels of psychological interventions.

Purpose

To identify nursing interventions for the management of adult patients undergoing cardiotoxic oncologic therapy.

Methods

This scoping review was performed in accordance with the JBI guidelines. The literature search took place between July and August 2022. Studies examining interventions for the management of adult cancer patients undergoing cardiotoxic therapy were included. The characteristics and results of the studies were synthesized and analyzed in a narrative way.

Findings

In the nine included studies, it was verified that the interventions were implemented to guide the actions of the health team in general rather than specifically nursing staff. Nine nursing interventions related to the Classification of Nursing Interventions were included.

Conclusions

The nursing interventions identified focused on rigorous cardiovascular surveillance, risk assessment, and actions to identify and mitigate cardiotoxicity.

Implications for Nursing Practice

It is believed that the implementation of the identified nursing interventions will lead to evidence-based nursing practice and will contribute to the development of care products and processes that assess the cardiological risks and cardiotoxicity.