bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Response to the Fast‐Track Experience
Authors: Flanagan Jane , Jones Dorothy
Published: August 2004

PURPOSE

To describe patients' functional health, symptom distress, and recovery at home across a fasttrack perioperative experience.

METHODS

A nonexperimental, descriptive, correlational design using pre/post test measures and openended questions captured the fast‐tracking experience. A convenience sample included 77 patients entering the same‐day surgery unit to undergo arthroscopy with general anesthesia and planned fast‐track recovery. In the preadmission test area, patients were asked by a nurse to participate in the study. If they agreed and met selection criteria, a nurse completed a demographic sheet, the Foster and Jones Functional Health Pattern Assessment Screeing Tool (FHPAST), and the Symptom Distress Scale (SDS).

On the evening of surgery, a nurse called the patient to review the SDS to be completed by phone. At 72 hours after surgery, the FHPAST, the SDS, and a 72‐hour open‐ended questionnaire were administered to understand the patient experience of fast‐tracking.

FINDINGS

At 12 hours nurses reported patients were “euphoric” and it was difficult to imagine pain or other symptoms. Some patients complained of nausea and fatigue. Most patients had family present. At 72 hours patients described unmet expectations, fatigue, immobility, ineffective pain management, sleep disturbance, and nausea. Interventions included teaching, coaching, and reassurance. Some patients continued to have nursing problems at 72 hours and benefited from a telephone follow‐up call.

CONCLUSIONS

Preliminary results suggest that nursing diagnoses, interventions, and outcomes can be used to describe patient responses to the fast‐track experience. Results indicate a need for practice changes to include innovative models and further research to measure outcomes. Fast‐tracking can be effective, but requires clinical reasoning by nurses to guide the individual's healing. A coaching intervention seems to enhance patient satisfaction and a sense of being cared for.
Standardized Care Planning: Evaluation of ICNP Beta in the Areas of Nutrition and Skin Care in a Practice Setting
Authors: Florin Jan , Ehrenberg Anna , Ehnfors Margareta
Published: August 2004

PURPOSE

To evaluate completeness, granularity, multiple axial content, and clinical utility of the beta version of the International Classification of Nursing Practice (ICNP®).

METHODS

Standardized care plans were developed based on research in the areas of nutrition and skin care and clinically tested in a 35‐bed infectious disease unit at a Swedish university hospital. A convenience sample of 56 computerized and manual patient records were content analyzed and mapped to the terms in ICNP® beta.

FINDINGS

A total of 1,771 phrases were identified. Approximately 60% of the record content describing nursing phenomena and about one third of the nursing interventions in the areas of nutrition and skin care could be expressed satisfactorily using the terminology of ICNP® beta. For about 25% of the content describing both nursing phenomena and interventions, no corresponding term was found. The most common deficiencies were focus terms for stating patient perspective or collaboration, nonhuman focus, normal findings, more qualitative judgments, and different expressions for stating duration. Some terms are available in the ICNP beta as a whole, but the organization of axes impedes or restricts the use of terms beyond the ICNP categories. Terms needed to express nursing phenomena could sometimes be found in nursing actions axes.

CONCLUSIONS

The ICNP® beta needs to be further developed to capture relevant data in nursing care. The axial structure needs to be evaluated, and completeness and granularity of terms need to be addressed further before ICNP beta can be used on a daily basis in the clinical setting. Terms need to be developed to express patient participation and preferences, normal conditions, qualitative dimensions and characteristics, nonhuman focuses as well as duration. Empirical studies covering the complexity of information in nursing care are needed.
Using NIC to Describe the Role of the Nurse Practitioner
Authors: Haugsdal Cindy S. , Scherb Cindy A.
Published: August 2004

PURPOSE

To have nurse practitioners (NPs) identify the 20 most prevalent NIC interventions describing their nursing practice; to determine if the NIC is applicable to the NP role.

METHODS

The study used a descriptive survey design. NPs with prescriptive privileges in the state of Minnesota received a cover letter and survey that included a description of NIC and a list of the 486 intervention labels and their definitions from the NIC (3rd ed.). Each participant was asked to identify all interventions performed at least once per month in their practice and to provide basic demographic data, including identification of NP specialty.

FINDINGS

A total of 1,190 surveys were mailed with a return rate of 37%. NPs' average age was 45 years; the average number of years of NP practice was 9. Employment in a clinic represented the work setting of 72% of respondents followed by hospital practice (11%) and long‐term care (10%). Specialty (certified) areas were family practice (27%), pediatrics (21%), adult (19%), women's health (16%), geriatrics (11%), psychiatric (5%), and oncology (1%). The educational level was primarily master's degree (73%).

NPs identified an average of 120 interventions they performed at least once per month. These interventions reflected areas of patient education and support, as well as documentation and physician collaboration. The 20 most frequently selected interventions were reported by 71%– 90% of respondents. Four core interventions —“documentation,”“telephone consultation,”“teaching: prescribed medication,” and “emotional support”— were used at least once per month by all specialties.

DISCUSSION

The level of consistency (70%) among responses validates the strong foundation that professional nursing, as described by NIC, provides NPs in their role. Four core interventions and the remaining 16 most frequently selected interventions that are more specific to each specialty practice indicates that NIC is comprehensive enough to meet the needs of a variety of NP practices.

CONCLUSIONS

NIC encompasses key areas of interventions (health screening, treatment and management, health promotion and education, psychosocial support, indirect activities) central to the role of NPs, but qualitative comments described the need for more language within NIC to characterize the NP role related to the prescribing of medications and treatments. Some respondents found the definitions to be unclear as to whether they were performing or ordering/prescribing the intervention. This lack of clarity could be addressed by further development of the NIC definitions and activities so the advanced role of the NP is more fully described.

Development of documentation systems using the core interventions identified by the various NP specialties is needed. Using standardized nursing language for documentation will enable NPs to build clinical databases that reflect and describe the role. Future research needs to be focused by NP specialty and to go beyond the NIC definition and include analysis at the activity level.
NLINKS: Online Research and Web Site Development
Authors: Lavin Mary Ann , Fletcher Ben
Published: August 2004

BACKGROUND

The Network for Language in Nursing Knowledge Systems (NLINKS) was the product of a 1998 NANDA Board of Directors brainstorming session. As a project, it was approved by the membership at the NANDA conference in Orlando, Florida in 2000. It became an online reality in fall 2001, and a summary of its development was presented at the NNN 2002 conference in Chicago, IL.

MAIN CONTENT POINTS

NLINKS provides the infrastructure needed for Web development opportunities in the field of language development. At present, NLINKS consists of the following components: Information page, an “About NLINKS” page, a Concept Analysis Center, a Research Center, and a Membership/Donor page. While anyone is free to use the information provided on the site, a paid membership in NLINKS confers two privileges that are especially relevant to networking worldwide. NLINKS members may use the site to conduct online research, or use the domain name and infrastructure to develop a Special Interest Center.

Research investigators may develop online surveys, diagnostic tests, online health promotion tools, as well as other applications for completion by visitors to the site or by subjects recruited by the investigators. Taxonomists, informaticists, international colleagues, and others may be interested in developing an NLINKS center for their own special interest purposes. The process from application through implementation is similar for researchers or special interest groups. It entails six steps: (a) designing a site map for the pages desired and accompanying business profile, (b) negotiating a price with NLINKS's coordinator and Web development firm, (c) submitting a research proposal with institutional review board approval if human research is to be conducted, (d) establishing formal contractual relationships among all parties, (e) raising funds or obtaining grant funds to cover the cost, and (f) constructing the research or special interest center pages with staff from the Web development firm.

CONCLUSIONS

Development and use continues as we strive to expand the site.
NLINKS: Online, Peer‐Reviewed Bibliographic References on Sleep
Authors: Lavin Mary Ann , Krieger Mary M. , McNary Patricia A. , Meyer Geralyn A. , Carlson Judith H. , Perry Anne G. , James Dottie
Published: August 2004

PURPOSE

To develop a methodology for establishing an online (http://www.nlinks.org), peer‐reviewed, annotated bibliography. Disturbed sleep patterns and sleep deprivation were the arbitrarily selected foci.

METHODS

Tasks included developing an annotated bibliographic form and collecting reviews, first from investigators and next from an online solicitation, and improving the annotated form as needed with the implementation of each of the following steps: (a) selecting MEDLINE and CINAHL search strategies for the years 1966–1982 and 1982–2001, respectively, (b) classifying an article's evidence base and its contribution to language development; (c) evaluating construct and content validity of the evidence base and the contribution to language development classifications, (d) determining interrater reliability in evaluating reviews, (e) publishing the results online, and (f) preparing for the deductive phase of the research and future research efforts.

FINDINGS

There was high interrater reliability within the contribution to language development scale but not within the evidence‐based scale. This finding led to a discussion on the evidence base of nursing. Comparisons between evidence base of medicine and nursing were made. A three‐tiered matrix was developed to allow for the cross‐categorization of level of nursing evidence with diagnoses, defining characteristics, related factors, interventions or treatments, and outcomes. Access to literature within any one cell of the matrix required knowledge of filters used by MEDLINE and CINAHL and adapting these filters to capture subject headings consistent with language development subjects and terms.

CONCLUSIONS

Future searches are planned and the implications for nursing informatics, education, practice, and research have been articulated. The move toward evidence‐based nursing is international in nature.
Evaluation of Impaired Physical Mobility in Patients With AIDS
Authors: Barbosa Dulce Aparecida , Myria Ribeiro  , Diniz Aparecido , Oliveira Susy Motta , Bettencourt Ana Rita
Published: August 2004

PURPOSE

To identify the defining characteristics and related factors of impaired physical mobility in patients with AIDS, according to NANDA criteria.

METHODS

Thorough physical exams of all patients with AIDS who were admitted during a single month were conducted. Related factors and defining characteristics for impaired physical mobility were documented.

FINDINGS

Study participants were 14 patients with AIDS (11 males, 3 females); median age was 34 (range: 23–44 years), and median time of hospital admission was 19 days (range: 7–40). Impaired physical mobility was diagnosed in 8 (57%) patients. The defining characteristics according to NANDA criteria were postural instability during routine activity (n= 6, 75%), and limited ability to perform fine motor activities (n= 4, 50%). The most evident related factors were sensoriperceptual impairment (n= 5, 62%); pain (n= 6, 75%); and decreased muscle strength, control, and/or mass (n= 3, 37%).

CONCLUSIONS

NANDA criteria provided essential support for impaired physical mobility.
Accuracy of Nursing Diagnosis: Interrater Agreement
Authors: Lopes Monteiro da Cruz Diná de Almeida , Rita de Cássia Grassia Peres
Published: August 2004

PURPOSE

To estimate the interrater agreement of the Lunney Scoring Method, a 7‐point scale (from −1 to +5) to measure accuracy of nursing diagnoses.

METHODS

This descriptive‐exploratory study with two raters applied the scale to 388 nursing diagnoses identified by 89 nurses and nursing students. Proportion of agreements and frequencies of score differences between raters were calculated. Cohen's Kappa was computed excluding 3 ratings of −1 assigned by only one of the raters.

FINDINGS

Raters agreed on 235 (61%) of the nursing diagnoses. The frequencies of score differences between raters were 1 point on 101 (21%) nursing diagnoses, 2 points on 11 (3%), and 3 points on 41 (11%). Kappa's coefficient was 0.51 (p<0.001).

DISCUSSION

There was acceptable agreement between raters using the Lunney Scoring Method. The proportion of score differences between raters can be interpreted as the magnitude of the disagreements, and revealed that differences of 3 points occurred in only 41 (11%) of the ratings.

CONCLUSIONS

Accuracy of nursing diagnosis is a matter of concern for practice, research, and teaching in nursing. The development, use, and refinement of instruments on nursing diagnosis accuracy would increase credibility for nursing diagnosis research. The application of such instruments in teaching and practice could facilitate sharing experiences between novices and expert diagnosticians. This study was carried out with a Portuguese (Brazil)‐speaking sample. Transcultural research on nursing diagnosis accuracy should be conducted to identify relevant cultural differences on diagnostic concepts. Such results could improve the international dialogue on nursing diagnostic concepts.
Risk Factors for Peripheral Neurovascular Dysfunction in Patients With Diabetes Mellitus and Arteriosclerosis Obliterans: A Pilot Study
Authors: Egawa Takako , Imai Yukika , Kurihara Hiroko , Hanafusa Moshiaki , Uehara Junko , Ogino Satoshi
Published: August 2004

PURPOSE

To develop a nursing diagnostic tool to help prevent foot disease in patients with diabetes mellitus at risk for developing peripheral neurovascular dysfunction.

METHODS

Subjects were 24 patients with diabetes mellitus. Ankle pressure index, percutaneous oxygen partial pressure (PtcO2), and circulation in the foot were measured using a laser flow meter. Neurologic disorders were evaluated using the Achilles reflex, sensory tests, and taste tests. Basic data (age, gender, fasting blood glucose as an indicator of the duration and severity of disease, hemoglobin, total cholesterol, lipids) were gathered from medical records. Patients were divided into two groups: those who had arteriosclerosis obliterans (10 males, 5 females) and those who did not (5 males, 4 females).

FINDINGS

There was a significant decrease in ankle pressure, PtcO2, and sensory perception in the feet of those with arteriosclerosis obliterans. There was also a significant decrease in taste sensation in this group.

CONCLUSIONS

These results suggest that patients with diabetes mellitus who have arteriosclerosis obliterans are already at risk for developing neurologic disorders and arteriosclerosis in the lower limbs. Clinical symptoms measured were able to determine risk for peripheral neurovascular dysfunction in patients with diabetes. The screening and assessment of these risk factors is noninvasive, making it possible for nurses to perform them by using their assessment skills.
Cleft Lip and Palate: Differences Between Pre‐ and Postoperative Nursing Diagnoses
Authors: Bertoncello Fontes Cassiana Mendes , Lopes Monteiro da Cruz Diná de Almeida
Published: August 2004

PURPOSE

To compare nursing diagnoses of patients undergoing cleft lip/palate correction between pre‐ and postoperative phases; to describe the related Functional Health Patterns according to frequencies of nursing diagnoses.

METHODS

Researchers assessed 40 patients hospitalized for cleft lip/palate correction by interview and physical examination before and after the surgical procedure. Four nurses independently made the nursing diagnoses for each patient based on the recorded data. The criterion to accept the diagnoses as valid was the consensus of a minimum of two out of four nurses. The MacNemar test was applied to verify whether the frequencies of the diagnoses changed after the surgery procedure.

FINDINGS

Nurses identified 454 diagnoses (35 categories). Knowledge deficit (p= 0.02), and self‐esteem disturbance (p<0.00) decreased in frequency after the surgical procedure. The frequencies of the following diagnoses significantly increased after surgery (p<0.00): risk for infection, risk for suffocation/aspiration, altered oral mucous membrane, sleep pattern disturbance, pain, fatigue, and impaired tissue integrity. The most altered Functional Health Pattern in the pre‐ and postoperative phases were Self‐Perception/Self‐Concept (28%) and Nutritional‐Metabolic (51%).

DISCUSSION

Preoperatively, care needs were related to psychosocial functioning. In the postoperative phase they were primarily related to biologic risks and comfort. Although these findings showed that surgery altered the response profile of the sample, differences in the forms used for the pre‐ and postoperative assessments might have contributed to these results.

CONCLUSIONS

The results of this study can be used to determine core competencies needed for nursing care in the area of craniofacial anomalies.
Evaluation of NOC Measures in Home Care Nursing Practice
Authors: Keenan Gail M. , Barkauskas Vi , Lee Jan , Stocker Julia , Treder Marcy , Clingerman Evelyn
Published: August 2004

PURPOSE

To evaluate the reliability, validity, usefulness, and sensitivity of 89 NOC outcomes in two Visiting Nurse Associations in Michigan.

METHODS

Of a total 190 NOC outcomes 89 were assigned for testing. Interrater reliability and criterion validity were assessed a total of 50 times per outcome (on 50 different patients) across the study units. The total number of times the reliability and validity were assessed for each of the 89 measures studied ranged from 5–45.

Three RN research assistants (RNRAs) oversaw and participated in data collection with the help of 15 clinicians. Convenience sampling was used to identify subjects. A roster of outcomes to be studied was maintained and matched with patient conditions whenever possible until the quota of outcomes assigned had been evaluated. Clinicians and RNRAs independently rated the outcomes and indicators applicable to the patient. NANDA diagnoses, NIC interventions, and medical diagnoses were recorded.

FINDINGS

A total of 258 patients (mean age 62) enrolled; 60% were women, 23% were from minority groups, and 78% had no college degree. Thirty‐six of the 89 NOC measures were designated “clinically useful.” The 10 outcomes with the highest interrater reliability were Caregiver Home Care Readiness; Caregiver Stressors; Caregiving Endurance Potential; Infection Status; Mobility Level; Safety Status: Physical Injury; Self‐Care: Activities of Daily Living; Self‐Care: Bathing; Self‐Care: Hygiene; and Wound Healing: Secondary Intention. Criterion measurement and repeated ratings provided evidence to support the validity and sensitivity of the NOC outcomes. Evidence also suggested that NOC label level ratings could be a feasible, reliable, and valid method of evaluating nursing outcomes under actual use. For some measures, adjustments in the scales and anchors are needed to enhance reliability. For others, it may be unrealistic to reliably score in one encounter, thus scoring should be deferred until the clinician has adequate knowledge of the patient.

CONCLUSIONS

Continued study and refinement that are coordinated and integrated systematically strongly recommended. Comprehensive study in an automated system with a controlled format will increase the efficiency of future studies.
Nursing Outcomes for Evaluations of Caregiver Outcomes in a Rural Alzheimer Demonstration Project
Authors: Specht Janet
Published: August 2004

PURPOSE

To evaluate the effectiveness of the interventions of nurse care managers in the care of family members of people with dementia.

METHODS

Data were collected as part of a 3‐year Administration on Aging–funded Alzheimer Demonstration Project to provide expanded in‐home services to rural Iowans affected by Alzheimer disease and related disorders in 8 rural Iowa counties—randomly selected to have a nurse care manager and 4 designated control counties that had traditional case management service. Nurse care managers were trained in the care of people with dementia and their caregivers, the use of role transition theory, and the Progressively Lowered Stress Threshold model of care to provide and coordinate services for enrollees. All referred people with cognitive impairment and their families in the 8 study counties were eligible for inclusion. Three selected NOC outcomes were tested in clinical settings. Interrater reliability for the outcomes was good (87%–95%). The construct validity of Caregiver Stressors Outcome was .74 when correlated with the Caregiver Stress Index.

FINDINGS

Of the 142 subjects with cognitive impairment enrolled within the first year of the grant, 113 had a caregiver. The outcomes were used to evaluate differences in caregiver outcomes at baseline and at 6‐month intervals. The majority of caregivers at follow‐up was female and had been providing care for ≥5 years. For each of the outcomes the majority of caregivers had improved scores, with only 2–4 caregivers getting scores indicating worsening conditions or remaining the same.

CONCLUSIONS

Preliminary analysis shows a trend of improved outcomes with the use of a nurse care manager. The NOC caregiver outcomes showed good variability among caregivers at baseline, with caregiver responses distributed throughout the scales. The NOC outcomes also provide guidance for interventions of the nurse care managers. Further evaluation of the outcomes is needed, including examining the relationships of placement, health status, and service use of each outcome. The caregiver outcomes offer an effective and efficient means to evaluate services delivered to caregivers of people with dementia.
Cognitive Coherence: Use of Nursing's Standardized Language
Authors: Graiver Mary M. , Shannon Marcia , Decker Sally
Published: August 2004

BACKGROUND

The framework of regulation/cognition/perception can be used in a baccalaureate curriculum to explore mental health and medical‐surgical life processes in a population of clients experiencing altered life processes.

MAIN CONTENT POINTS

An example from mental health is the phenomenon of mood. Specific NANDA labels include impaired social interaction and ineffective individual coping. NIC labels that apply include “socialization enhancement” and “behavior management: self‐harm.” NOC labels include Social Involvement and Decision Making. In a medical‐surgical setting the phenomenon of nutrition can be used as an example. NANDA labels include altered nutrition: more than body requirements. NIC labels include “nutrition management,”“weight reduction assistance,” and “weight management.” NOC labels include Weight Control, Knowledge: Diet, and Nutrition Status: Food and Fluid Intake.

CONCLUSIONS

These examples of the use of standardized language within a nursing curriculum demonstrate the linkages that are possible within specific courses as well as throughout those courses united by a common conceptual framework.
Nursing Rounds Link Nursing Diagnoses to Clinical Practice
Authors: Jaco Mary K. , Gordon Mary D. , Marvin Janet A.
Published: August 2004

BACKGROUND

A pediatric burn nursing internship program was developed to train new graduate nurses to become competent and confident in their practice. The goals were to teach critical thinking, develop individualized plans of care for patients with burns, and guide the development of sound nursing practice. The strategy was to build the curriculum around nursing diagnoses. Theoretical content of the program included pediatrics, burns, and critical care nursing.

MAIN CONTENT POINTS

The format for linking the patient, the problem, and nursing practice was nursing rounds. Each class day began with a nursing round focused on an assigned topic for the day: growth and development, pulmonary, cardiovascular, gastrointestinal, fluid and electrolytes, integumentary, resuscitation of a burn patient, or nutritional/metabolic and psychosocial needs. A student assessed the assigned patient, reviewed existing patient data, identified the appropriate nursing diagnoses, and recommended changes to the existing plan of care. A concept map (a schematic representation of the relationship of defining characteristics, related factors, and nursing interventions) was developed as an adjunct tool to diagram the desired components. The presentations were made to senior nursing staff and preceptors who critiqued the work and provided other feedback.

CONCLUSIONS

This educational process was a guided learning activity with multiple benefits, including incorporation of critical thinking into practice by individualizing the plans of care and recognizing relationships between nursing theory and practice. The unexpected benefits were the increased presence of the nurturing role by senior staff, increased familiarity of students with other staff members, and increased awareness of the plan of care by all staff. A future study of this process includes outcome evaluation as it is incorporated into daily practice for senior as well as novice nurses.
Nursing Classification Language to Describe Family Presence During Resuscitation and Invasive Procedures
Authors: Lamont Scott Chisholm
Published: August 2004

PURPOSE

To suggest appropriate classification labels and definitions that accurately reflect family presence.

METHODS

Based on a comprehensive review of the literature, content analysis of selected case studies was performed. Themes and details were identified. Concept analysis was then performed sequentially for the implied nursing diagnoses, outcomes, and interventions to determine labels and definitions, based on the discovered themes and details.

FINDINGS

Family nursing care is oriented toward diagnosis and treatment of family responses to illness within the family unit. It is clear from the current literature that many families wish to be present when a family member undergoes resuscitation; however, no nursing diagnosis exists for this identifiable response to an acute crisis within the family unit. Based on the data gathered, a family nursing diagnosis, “supportive family,” is proposed. Taxonomically this diagnosis best fits in the Role Relationships domain of the NANDA Taxonomy II. Additionally, a new label needs to be created in NIC within the Family domain, under the class of “life span care” labeled family presence facilitation. The goal of family presence facilitation as a family systems nursing intervention is to ease normal grieving, support normal family coping, and empower families. NOC includes several outcomes that may be appropriate for evaluating individual and family responses to family presence facilitation; however, an outcome focused on the specific assessment findings diagnostic of a supportive family, labeled Family Member Support, within the Family Health domain is proposed.

CONCLUSIONS

Further research must be done to validate the nursing classification language appropriate for this practice. Additionally, research using these proposed terms must be performed to demonstrate both clinical usefulness and the outcomes actually achieved. A method for tracking outcomes and identifying problems must be developed, and the data captured must be broadly shared.
Utilization of Nursing Diagnoses by Students During a Pediatric Nursing Course in Turkey
Authors: Erdemir Firdevs
Published: August 2004

PURPOSE

To determine the utilization of nursing diagnoses by nursing students and their ability to formulate the NANDA nursing diagnoses under the functional health patterns to evaluate whether there is a link between documented nursing diagnoses and patients' assessment data.

METHODS

Data were obtained from the standardized nursing assessment forms and care plans documented by 57 nursing students in a pediatric nursing course. A total of 569 care plans were documented for patients (children and their families).

FINDINGS

For 569 children in 3 different pediatric clinics, 70 different nursing diagnoses were documented. Some of the nursing diagnoses were used in various frequencies for a total of 3,433 documented diagnoses in Nutrition‐Metabolic (n= 1,274), Activity‐Exercise (n= 594), Cognition‐Perception (n= 572), Role Relationships (n= 330), and Health Perception‐Health Management (n= 327) Health Patterns. The most frequently occurring NANDA diagnoses were knowledge deficit (n= 275), altered nutrition: less than body requirement (n= 265), risk for altered body temperature (n= 263), anxiety (n= 236), and altered comfort (n= 227).

CONCLUSIONS

The majority of the students had adequate knowledge and ability to formulate nursing diagnoses according to NANDA, but documented diagnoses were not always supported by patients' assessment information. This might be a result of the inadequate diagnostic reasoning and teaching methods used, and being introduced to the diagnostic process for the first time in this course. Ultimately, consistent expectations and using the classification systems will lead to competency in diagnostic reasoning.
Implementation of Standardized Nursing Language at a University
Authors: Powelson Stephanie , Leiby Kristen
Published: August 2004

PURPOSE

To evaluate the implementation of the standardized nursing languages (SNL) of NANDA, NIC, and NOC at a midwestern baccalaureate nursing program over four years.

METHODS

Nursing faculty developed 6 items to rate responses using a Likert‐type scale (1 = low to 5 = high.) Two open‐ended questions were included. Faculty and student evaluations shared 4 common items, while 2 items were slightly different. Respondents' evaluations (juniors, seniors, and faculty) over 4 years were compared. Each year approximately 10 faculty and 60 students responded to the survey.

FINDINGS

Respondents rated the use of SNLs as follows: helpful as a resource (mean ≥4.0), pertinent to the course (mean ≥3.8), pertinent to clinical (mean ≥4.0), and compatible with Watson's Caring Theory (mean ≥4.0). Over 4 years, faculty members' ratings have increased while students' ratings have slightly decreased. Comments revealed the need for additional orientation and more in‐depth discussion about relating SNLs to individualized patient care.

CONCLUSIONS

Continued research at this university, at other schools of nursing, and in practice settings is needed to evaluate student and faculty satisfaction after introducing standardized nursing languages in planning and documenting patient care.
Itinerant Group: An Innovative Proposal for the Study of Nursing Diagnosis
Authors: Almeida Miriam de Abreu , Araújo Valéria Giordani
Published: August 2004

BACKGROUND

A nursing diagnosis study group was created in 1994 as a university extension activity organized by professors of the Nursing School of Universidade Federal do Rio Grande do Sul, in the south of Brazil. Nurses and professors met weekly to exchange information and promote discussion about nursing care, with emphasis on nursing diagnosis. In 1996 the group linked to the Brazilian Nursing Association Section in order to expand this work to the professional community.

MAIN CONTENT POINTS

This group committed itself to organize meetings open to all the nursing professionals interested in exchanging experiences about nursing care and nursing diagnosis, through the presentation of case studies and papers. In order to facilitate participation and integration of professionals from different health institutions and nursing schools, an itinerant group was formed. From 1999 to 2000 meetings were held in seven different hospitals in the city. The number of participants varied from 19 to 40 people and included students, nurse helpers, and technicians from 6 universities and 15 healthcare institutions.

CONCLUSIONS

This experience has been successful in spreading the use of and discussing nursing diagnosis. After a period without meetings, the group will restart in 2002.
Development of a System for Nursing Diagnosis and Intervention Management
Authors: Park Sung Ae , Park Jung Ho , Jung Myun Suk , Lee Hiye Ja , Joo Mi Kyoung , Park Sung Hee
Published: August 2004

BACKGROUND

After analyzing the relationship between 10 medical diagnoses and the NANDA classification, a set of related links between medical diagnoses and nursing diagnoses was drafted for the medical/surgical unit. Because one nursing diagnosis is related to many nursing interventions, the relationships established by the NIC study team between NANDA diagnoses and NIC interventions was used.

MAIN CONTENT POINTS

System programs are divided into five modules: user interface, management of standardized data, searching expected nursing diagnoses and interventions, management of nursing activities, and statistics retrieval. The database consists of two parts: knowledge and activity. All data maintained by the modules for management of standardized data are stored in the knowledge database. The modules for searching expected nursing diagnoses and interventions also use the knowledge database. All data produced by the modules for management of nursing activities and the modules for retrieving statistics on nursing activities are stored in the activity database.

The system will be operated in connection with an order communication system currently in use in hospitals. Therefore, development tools were selected considering this connection.

The menus for system operations are divided into four parts: management of master data, management of patient and nurse information, management of nursing activity, and retrieving statistics on nursing activity. The part for management of master data consists of five submenus: medical diagnosis, nursing diagnosis, nursing interventions, relationships between medical diagnosis and nursing diagnosis, and relationships between nursing diagnosis and nursing intervention. Through the user interface screen, nurses select medical diagnoses and then confirm the nursing diagnoses suggested.

CONCLUSIONS

The system will help nurses perform their nursing processes more efficiently. However, further studies of the system are mandatory. After verifying the usefulness of the system, further analysis of the relationship between medical diagnoses and nursing diagnoses is also necessary.
Comparisons of NANDA/NIC/NOC Linkages Between Nursing Experts and Nursing Students
Authors: Van De Castle Barbara
Published: August 2004

PURPOSE

To compare and contrast student and expert clinical content associations (linkages) of NANDA, NIC, NOC.

METHODS

All undergraduate students (288) were asked to voluntarily submit their care plans, with nursing diagnoses, associated interventions, and associated outcomes. The criterion for care plan inclusion was use of official NANDA diagnoses, NIC interventions, and NOC outcomes. A total of 235 care plans were submitted; 203 met the criteria. Students participated from four clinical rotations: childbearing family, child health, adult physical health, and adult emotional health. A database was created to allow entry of the expert's choices for interventions and outcomes based on a given nursing diagnosis as published in the NIC and NOC textbooks. Another database was created to enter the student NANDA/NIC/NOC links obtained from care plans. The two files were compared to assess differences between linkage sets.

FINDINGS

Fifty‐six percent of students chose interventions or outcomes outside of the provided links in the NIC and NOC texts. This finding corresponds with data found in an earlier study.

The interventions and outcomes chosen reflect current care priorities emphasized in acute care management. A total of 50 different nursing diagnoses were chosen by the students using 606 interventions (338 nonduplicated), and 244 outcomes (145 nonduplicated). The most frequent diagnosis chosen was knowledge deficit, the most frequent NOC was Pain Level, and the most frequent NIC was “discharge planning.”

DISCUSSION

These findings suggest that students using this type of care plan structure and resource are developing critical thinking skills. Choosing interventions and outcomes from a generic list and not from a prepared list can demonstrate clinical decision making. Faculty can evaluate student application of course objectives by the type and frequency of the diagnoses, interventions, and outcomes cited. For instance, the above finding of “discharge planning” as the most frequent intervention told faculty that the strategies used to encourage student incorporation of discharge planning was effective.

CONCLUSIONS

This study showed that students are going beyond the provided linkages in the NIC and NOC texts and choosing appropriate interventions and outcomes. Critical thinking skills are being used in developing care plans. More research assessing clinically derived linkages among NANDA, NIC, and NOC is needed, but should be expanded to linkages created by nurses. Additionally, clinical information systems linking diagnoses, interventions, and outcomes should not be limited to predetermined linkages but should allow for flexibility to include additional choices appropriate to specific patient management concerns. An ongoing assessment of clinical information systems using any of the nursing classifications is key to developing clinically appropriate and culturally sensitive linkages.
Nursing Diagnoses in Japan and Issues Related to Their Development
Authors: Tanaka Makiko
Published: August 2004

PURPOSE. To examine the awareness of nursing diagnosis in Japan by investigating the reality of its spread and permeation.

METHODS. One group (X) consisted of 67 individuals who were unfamiliar with nursing diagnosis, while the other group (Y) consisted of 20 who were practicing it. The awareness of nursing diagnosis was measured via a researcher‐developed questionnaire. A comparative analysis was made between the two groups.

FINDINGS. The cross analysis for group X between “the awareness of improving the nursing diagnosis ability” and “the awareness of the necessity for nursing diagnosis” was significant (p<0.001). Open‐ended responses to the question, “What does nursing as a profession consist of?” were categorized into five factors. Triple cross‐analysis of both groups on each factor yielded one significant result for Group Y with the factor “nursing diagnosis was necessary but improving ability to use it was another matter” (p<0.05).

CONCLUSIONS. The subjects' familiarity with nursing diagnosis was systematically related to its evaluation, causing ambivalent feelings toward it. Also, regardless of subjects' familiarity with nursing diagnosis, there was a feeling that it is a difficult skill to master. While subjects felt skill using nursing diagnosis was prestigious, their sense of a lack of this skill led to blocking its spread and permeation.
Nursing Diagnosis in Medical‐Surgical Patients
Authors: Volpato Márcia Paschoalina
Published: August 2004

PURPOSE. To identify nursing diagnoses identified in patients in a medical‐surgical unit.

METHODS. Data were collected through interviews and physical examination of 60 patients on a female ward in order to formulate NANDA diagnoses. The data collection tool was based on Gordon's 11 Functional Health Patterns. Four researchers with medical‐surgical nursing expertise reached the nursing diagnosis through consensus.

FINDINGS. A total of 338 diagnoses were identified from 49 different categories. Nineteen categories were identified in more than 10% of the sample: risk for infection (58%), pain (50%), constipation (42%), activity intolerance (35%), sleep pattern disturbance (28%), altered physical mobility (27%), impaired skin integrity (27%), fatigue (25%), sexual pattern dysfunction (23%), anxiety (23%), risk for ineffective manipulation of therapeutic regimen (20%), risk for trauma (20%), risk for impaired skin integrity (18%), ineffective coping (18%), altered nutrition: more than body requirements (12%), impaired communication (12%), urinary incontinence (10%), fluid volume excess (10%), and altered nutrition: less than body requirements (10%).

The most frequent diagnoses related to Health Functional Patterns were identified in health control and perception, with 28% of the 338 formulated diagnoses, activity‐exercise and nutritional‐metabolic with 20% each.

CONCLUSIONS. There was great diversity in the quality of the reported needs in the studied sample, which demands extensive knowledge and a wide range of abilities to identify needs as well as implement care in the affected patients. Studies such as this one will enhance delineation of the nursing knowledge base in order to justify allocation of human resources in specific areas.
Caregivers of Patients With Chronic Pain: Responses to Care
Authors: Monteiro da Cruz Diná de Almeida Lopes , de Mattos Pimenta Cibele Andrucioli , Kurita Geana Paula , de Oliveira Ana Cláudia , Boisvert Cécile , Kamitsuru Shigemi , Ugalde Mercedes
Published: August 2004

PURPOSE To explore the caregiving role of nonprofessional caregivers of patients with chronic pain.

METHOD Descriptive study of 30 caregivers.

FINDINGS Twenty‐eight (93%) caregivers demonstrated 1 to 6 defining characteristics of caregiver role strain, and 2 (7%) had at least two factors of risk for caregiver role strain.

CONCLUSION Caring for patients with chronic pain has a meaningful impact on caregivers' lives.

PRACTICE IMPLICATIONS Caregivers of patients with chronic pain deserve care, not only with the objective of optimizing relief for the patients, but also to help them seek and attain optimal functionality.
Formulation of a Plan of Care for Culturally Diverse Patients
Authors: Walsh Susan , Boisvert Cécile , Kamitsuru Shigemi , Michel Jeanne , de Barros Alba , Ugalde Mercedes
Published: August 2004

PURPOSE To formulate a plan of care for a culturally diverse population and develop a resource for the healthcare team in providing culturally competent care.

DATA SOURCES Books, journal articles.

DATA SYNTHESIS Healthcare workers are challenged to provide appropriate care for an increasingly diverse population. A cluster of nursing diagnoses were used to develop a plan of care addressing the unique challenges of caring for a diverse population served by a community hospital.

CONCLUSION A care plan was devised and inserted into the nursing diagnosis–based nursing documentation computer system for easy access when needed.

PRACTICE IMPLICATIONS A care plan for a diverse population can promote respectful and excellent care for every patient.
Contexts for the Study of the Economic Influence of Nursing Diagnoses on Patient Outcomes
Authors: Lavin Mary Ann , Avant Kay , Craft‐Rosenberg Martha , Herdman T. Heather , Gebbie Kristine , Michel Jeanne , de Barros Alba , Apalategui Mercedes Ugalde
Published: August 2004

PURPOSE To examine the historical, legal/organizational, informatics, clinical, economic, and policy contexts underlying economic consequences of nursing diagnoses on patient outcomes.

DATA SOURCES Published literature, online material.

DATA SYNTHESIS Nursing diagnoses influence diagnostic‐specific patient outcomes and other outcome variables such as length of hospital stay, morbidity, and mortality.

CONCLUSIONS Examination of the economic ramifications of nursing diagnosis on patient outcomes can be facilitated using standardized language and databases containing nursing‐sensitive measures.
Diagnostic‐Specific Outcomes and Nursing Effectiveness Research
Authors: Moorhead Sue , Johnson Marion , Michel Jeanne , de Barros Alba , Apalategui Mercedes Ugalde
Published: August 2004

PURPOSE To review the use of diagnosis‐specific outcomes in health care and nursing.

DATA SOURCES Published literature, information databases.

DATA SYNTHESIS The need to identify nursing diagnosis–specific outcomes is necessary in order to expand nursing's knowledge base and identify the cost‐effectiveness of nursing interventions.

CONCLUSIONS Outcomes work needs to be done across settings where care is provided.

PRACTICE IMPLICATIONS Outcomes information is necessary to identify the cost and impact of nursing interventions.
Population Pharmacokinetics of Indinavir in Patients Infected with Human Immunodeficiency Virus
Authors: Csajka Chantal , Marzolini Catia , Fattinger Karin , Décosterd Laurent A. , Telenti Amalio , Biollaz Jérôme , Buclin Thierry
Published: August 2004

Indinavir is currently used at a fixed dose of 800 mg either three times a day or twice a day in combination with 100 mg of ritonavir. Dosage individualization based on plasma concentration monitoring might, however, be indicated. This study aimed to assess the pharmacokinetic profile of indinavir in patients infected with human immunodeficiency virus to characterize interpatient and intrapatient variability and to build up a Bayesian approach for dosage adaptation. A population analysis was performed with the NONMEM computer program with 569 plasma samples from a cohort of 239 unselected patients receiving indinavir. A one-compartment model with first-order absorption was adapted, and the influences of clinical characteristics on oral clearance (CL) and distribution volume (
V
) were examined. Predicted average drug exposure and trough and peak concentrations were derived for each patient and correlated with efficacy and toxicity markers. The population estimates of CL were 32.4 liters/h for female and 42.0 liters/h for male patients; oral
V
was 65.7 liters; and the rate constant of absorption (

K
a

) was 1.0 h
−1
. CL decreased by 63% with ritonavir intake and was moderately correlated to body weight. Both interpatient variability, best assigned to oral CL (coefficient of variation [CV], 39%) and

K
a

(CV, 67%), and intrapatient variability were large (CV, 41%; standard deviation, 670 μg/liter). In conclusion, initial indinavir dosage should be decided according to ritonavir intake and sex, prior to plasma concentration measurements. The high interpatient pharmacokinetic variability represents an argument for therapeutic drug monitoring.