bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Implication of Trigeminal Sensitization in Acute and Chronic Migraine: A Review
Authors: Lipton Richard B. , Bigal Marcelo E.
Published: August 2004

It has been proposed that, early in the course of a migraine attack, sensitization of the first order trigeminal nerve occurs manifesting itself in throbbing pain. In 75% of migraine sufferers, eventually sensitization of the second order trigeminal neuron occurs (central sensitization [CS] manifested by cutaneous allodynia [CA]. Studies show that the efficacy of triptans and other acute treatments is much higher if they are given while pain is mild. Other studies suggest that it is the presence of CS/CA that predicts treatment response. Repeated development of CS has been identified as a candidate risk factor for the development of transformed migraine. If so, avoiding CA (therefore avoiding CS) may provide a strategy for preventing headache progression. In this article, we discuss the therapeutic implications of CS in episodic and transformed migraine.
Peripheral and Central Sensitization: Expert Commentary on Selected Abstracts
Authors: Graff‐Radford Steven B.
Published: August 2004

Central Trigeminal Sensitization May be Mediated by Nonmeningeal Nociceptive Trigeminal Afferents and Influenced by Sex Hormones

We have previously shown that injection of the inflammatory irritant and small‐fiber excitant mustard oil (MO) into the temporomandibular joint (TMJ) region can reflexively induce a prolonged increase in the activity of both digastric and masseter muscles in rats. It is possible that peripheral excitatory amino acid (EAA) receptors play a role in this effect, because MO‐evoked increases in jaw muscle activity are attenuated by preapplication of the noncompetitive NMDA receptor antagonist MK‐801 into the TMJ region. In the present study, the EAA receptor agonists glutamate, NMDA, kainate, and AMPA were applied locally to the TMJ region. Jaw muscle responses similar to those evoked by MO application to the TMJ region were achieved with glutamate, NMDA, AMPA, and kainate. Repeated application of glutamate, NMDA, or AMPA at intervals of 30 min evoked responses in the ipsilateral jaw muscles that were of comparable magnitude. Co‐application of the NMDA receptor antagonist DL‐2‐amino‐5‐phosphonovalerate (0.5 μmol) significantly reduced the magnitude of the glutamate‐ and NMDA‐evoked ipsilateral jaw muscle responses without affecting responses evoked by AMPA. In contrast, co‐application of the non‐NMDA receptor antagonist 6‐cyano‐7‐nitroquinoxaline‐2,3‐dione (1 nmol) significantly reduced the magnitude of the glutamate‐ and AMPA‐evoked ipsilateral jaw muscle responses without affecting responses evoked by NMDA. This evidence suggests that both NMDA and non‐NMDA EAA receptor types are located within the TMJ region and may contribute to jaw muscle activity that can be reflexively evoked from the TMJ region.
Critical Thinking and Accuracy of Nurses' Diagnoses
Authors: Lunney Margaret
Published: August 2004

Interpretations of patient data are complex and diverse, contributing to a risk of low accuracy nursing diagnoses. This risk is confirmed in research findings that accuracy of nurses' diagnoses varied widely from high to low. Highly accurate diagnoses are essential, however, to guide nursing interventions for the achievement of positive health outcomes. Development of critical thinking abilities is likely to improve accuracy of nurses' diagnoses. New views of critical thinking serve as a basis for critical thinking in nursing. Seven cognitive skills and ten habits of mind are identified as dimensions of critical thinking for use in the diagnostic process. Application of the cognitive skills of critical thinking illustrates the importance of using critical thinking for accuracy of nurses' diagnoses. Ten strategies are proposed for self‐development of critical thinking abilities.
Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels
Authors: Cavendish Roberta , Konecny Lynda , Mitzeliotis Claudia , Russo Donna , Luise Barbara Kraynyak , BS Melissa Lanza , Medeíindt Judith , Bajo Mary Ann McPartlan
Published: August 2004

PURPOSE. To describe the spiritual care activities of nurses as subsequently identified in the Nursing Interventions Classification (NIC) labels.

METHODS. Data were taken from a larger study that used a multiple triangulation research design to describe spiritual perspectives, interventions, and attitudes of 1,000 Sigma Theta Tau International members. Data analysis included descriptive and multivariate statistics for quantitative items, and content analysis for responses to questions.

FINDINGS. 97 respondents reported providing 32 spiritual care activities. Ten NIC labels actually mapped the nurses' spiritual care activities.

CONCLUSIONS. Spiritual care activities involve a broad spectrum of interventions that may be unique to each patient. The 32 spiritual care activities described by the nurses provide new knowledge regarding core spiritual care activities. The use of NIC labels can facilitate documentation of spiritual care activities in diverse practice settings.

PRACTICE IMPLICATIONS. This study supports greater specificity in describing spiritual care interventions to a level that allows replication and advancement of knowledge.

Search terms: Nursing activities, nursing interventions, spiritual care
Occupational Nursing Service in a Small Manufacturing Plant: Interventions and Outcomes
Authors: McKeown Elaine , Barkauskas Vi , Quinn Amy , Kresowaty Jeannette
Published: August 2004

PURPOSE. To describe the health needs presented by workers in a small industrial setting, describe the occupational health nursing (OHN) services provided, and examine the effectiveness of these services.

METHODS. Data were abstracted from 491 employee records accumulated over a 7‐year service period. Standardized nursing languages were used to describe employee needs and nursing interventions.

FINDINGS. Data revealed 1,368 needs were identified and 3,193 nursing interventions were administered. Health‐seeking behaviors, knowledge deficit, collaborative problems, risk of infection, and impaired tissue integrity seemed most amenable to change in the context of OHN services. Altered health maintenance was the problem that seemed least amenable to change.

CONCLUSIONS. Findings present a dynamic picture of OHN services provided in an OHN program and their effectiveness. Standardized nursing languages were effective and appropriate in describing the health issues managed and interventions applied.

PRACTICE IMPLICATIONS. Further use of standardized nursing languages in occupation health can establish core functions and knowledge base.

Search terms: Nursing diagnosis, nursing interventions, nursing outcomes, occupational health nursing
Nursing Diagnosis Extension and Classification: Ongoing Phase
Authors: Craft‐Rosenberg Martha , Jirathummakoon Saovaluck
Published: August 2004

BACKGROUND The Nursing Diagnosis Extension and Classification Project (NDEC) has been active for almost a decade. The team began with the formation of a team of investigators at The University of Iowa College of Nursing. From 1994 until 2000 the research team consisted of 16 investigators who were experts in nursing care across the lifespan. They also represented expertise in both qualitative and quantitative research. The aims of the NDEC research are to evaluate and revise NANDA diagnoses, to validate the diagnoses using a clinical information system, and to develop candidate diagnoses.

MAIN CONTENT POINTS

Phase 1 of the NDEC research has yielded 116 refined and developed nursing diagnoses that have been submitted to NANDA. Of these, 65 have been approved and 54 appeared in Nursing Diagnoses: Definitions and Classification, 1999–2000 along with 39 NDEC products. In the 2000–2001 edition, 7 diagnoses refined by NDEC and 7 new diagnoses submitted by NDEC are included.

As only about half the NDEC products have appeared in NANDA publications, the three‐level review process (Diagnosis Review Committee, membership, and Board) has been discussed with the NANDA board. This request is currently being honored by the Diagnosis Review Committee; however, review by the membership and review by the NANDA board is just beginning to move in this direction.

Phase 2, clinical validation of the NDEC work, is being conducted at a long‐term care facility. It will also be conducted at a large teaching hospital. All the NDEC refinement and development work has been submitted for clinical validation. Currently validation is planned at the label level only.

Phase 3 involves identification of candidate diagnoses. Many of the candidate diagnoses were developed during the concept analysis phase, when NDEC team members identified the need for additional diagnoses. Nurses in practice have submitted other candidate diagnoses. In total 195 candidate diagnoses have been identified and placed into a database.

In order for the NDEC team to make decisions regarding priorities for diagnosis development, the diagnoses in the candidate database are compared to diagnoses in other classifications that have already been developed. Several classifications are used for comparison including the Omaha System and the Home Health Care Classification. A large table is used to compare candidate label to other labels. Candidate diagnosis included in other classifications will be given lower priority for development by NDEC.

CONCLUSIONS

The NDEC work plan includes work on diagnoses to be resubmitted to the NANDA Diagnosis Review Committee. It is hoped that the Web site for NLINKS will facilitate the work of diagnosis refinement and development. NDEC will continue to work with any investigator who is seeking assistance. The last part of the work plan is resource acquisition and recruitment of investigators to continue the refinement and development of diagnoses.
Fatigued Elderly Patients With Chronic Heart Failure
Authors: Ehrenberg Anna , Ekman Inger
Published: August 2004

PURPOSE

To compare descriptions of fatigue based on the NANDA characteristics from interviews with elderly people with congestive heart failure (CHF) and data recorded by nurses at a Swedish outpatient heart failure clinic.

METHODS

Patients were screened for moderate to severe CHF. A total of 158 patients were interviewed using a revised form of the Fatigue Interview Schedule (FIS) based on the NANDA characteristics. Of these patients, half (n= 79) were offered visits at a nurse‐monitored heart failure clinic. Nursing documentation of fatigue at the heart failure clinic was reviewed based on the NANDA characteristics and compared with the content in the patient interviews.

FINDINGS

Tiredness was documented in 43 (75%) records and indicated in 36 patients based on patient scores on the FIS (X̄= 5.5; range 1–9). The most frequently recorded observation related to fatigue was the symptom emotionally labile or irritable, followed by notes on lack of energy and decreased performance. Patients' descriptions of their fatigue were expressed as a decreased ability to perform and a perceived need for additional energy. Results indicated poor concordance in patients' descriptions and record content concerning fatigue. Whereas patients emphasized the physical characteristics of fatigue, nurses emphasised the emotional features. Decreased libido was linked to fatigue according to the patients but not according to the nurses' records. Whereas cognitive characteristics of fatigue occurred rarely in the records, they were more frequent in the patient interviews.

DISCUSSION

Symptoms such as irritability and accident‐proneness may be seen as manifestations of the patients' experiencing the need for more energy or a feeling of decreased performance. These consequences of being fatigued, rather than the different dimensions of fatigue, seemed to have been easy for the nurses to observe and document. Earlier studies indicate that poor observation, medication, and diet in patients with heart failure might partly be explained by cognitive impairment.

CONCLUSIONS

Findings of this study highlight the need for nurses to pay attention to the experience of fatigue in patients who suffer from CHF, and to validate their observations with the patients own expressions. Using the patients' words and expressions and the diagnostic characteristics of fatigue in recording can support the nurses in developing both understanding of patients living with CHF and strategies to help patients cope with their restricted ability in daily life.
Evaluation of Interventions Proposed for Altered Tissue Perfusion: Cardiopulmonary in Patients Hospitalized With Acute Myocardial Infarction
Authors: Gomes Ivanise Maria , Leite de Barros Alba Lucia Botura , Pereira Lima Grace Maria
Published: August 2004

PURPOSE

To evaluate the effectiveness and efficacy of the interventions proposed for patients with altered tissue perfusion: cardiopulmonary, according to NIC and NOC taxonomies.

METHODS

Prospective and descriptive study carried out in the cardiology unit of a school hospital with patients under clinical treatment followed from admission until discharge. Patient data were collected using the unit's assessment tool and nursing diagnoses were established. Daily activities were proposed for these patients based on NIC interventions “cardiac care: acute,”“cardiac care,” and “cardiac care: rehabilitative.” Results were evaluated according to indicators selected from NOC's Tissue Perfusion: Cardiac.

FINDINGS

The sample comprised 25 patients (12 males, 13 females), age range 39 to 83 years. Days hospitalized averaged 3.5 in the coronary unit and 3.5 in the cardiology infirmary, for a total of 7 hospital days. The nursing diagnosis was made based on defining characteristics: enzymatic and ECG changes were found in 100% of the patients, chest pain (96%), diaphoresis (80%), and nausea (72%). The related factor in evidence for 100% of the sample was coronary arterial flow interruption. Patients were evaluated according to NOC outcomes both before starting activities and daily, with the following results: chest pain — 64% of patients initially presented pain with score 1, most (72%) presented scores 4 and 5 on day 2; on days 3, 5, 6, and 7 of hospitalization, all patients reported absence of pain (score 5). On day 4 only, 4% of patients reported pain with intensity 7 (score 2). Profuse diaphoresis was found in 80% of the sample on day 1 of hospitalization, and that disappeared in the course of the remaining days. Nausea was found in 44% of the population with score 1 on day 1 of hospitalization, and disappeared subsequently. Most the patients (84%) did not present with vomiting. Also, no evidence was found of vital sign changes in most of the sample. ECG presented score 1 in 72% of the sample on day 1, greatly decreasing from day 2. Cardiac enzymes appeared in 100% of the sample, decreasing in subsequent days. Heart ejection fraction, pulmonary artery pressure, heart rate, and myocardial scanning indicators were not measured.

CONCLUSIONS

Indicators evaluated achieved score 5 (no compromise) on hospital discharge in 100% of patients, which evidences effectiveness of the interventions performed.
NOC Implementation and Testing in a Cardiac Surgery ICU
Authors: Demmer Kathy
Published: August 2004

BACKGROUND

Nursing has increasingly found itself in the position of having to demonstrate it makes a difference in the outcome of a patient's recovery. How care is documented plays an important role in validating the effect nursing interventions have on patient outcomes. Standardized nursing languages have been and are being developed to provide a common basis of documentation, communication, and comparison of nursesensitive patient outcomes.

MAIN CONTENT POINTS

Two cardiac surgery ICUs participated as clinical test sites for The University of Iowa continuation grant to refine and validate measures for NOC outcomes. In the cardiac transplant ICU, data were collected on 42 outcomes: 30 had an average interrater reliability of ≥85%; 16 had an absolute agreement interrater reliability of ≥85%. The top 4 outcomes using 80% of the indicators were Communication Ability, Neurological Status, Tissue Integrity: Skin and Mucous Membranes, and Vital Sign Status. The bottom 4 outcomes using ≤51% of the indicators were Nutritional Status: Food and Fluid, Respiratory status: Ventilation, Tissue Perfusion: Cardiac, and Safety Behavior: Fall Prevention.

In the cardiac surgery ICU, data were collected on 30 outcomes: 25 had an average interrater reliability of ≥85%; 6 had an absolute interrater reliability of >85%. The top 5 outcomes using ≥87% of the indicators were Blood Transfusion Reaction Control, Knowledge: Medication, Pain level, Vital Sign Status, and Nutritional Status: Nutrient Intake. The bottom 4 outcomes using ≤54% of indicators were Comfort Level, Infection Status, Tissue Perfusion: Cardiac, and Safety Behavior: Fall Prevention.

The study implementation process included meetings and inservice classes (many one on one) with nursing leadership, resource “super user” RNs, and other staff RNs. Several 1‐hour educational inservice classes were offered. Once the study was progressing, charts, e‐mail messages, reminder notes, and attending and reporting study progress at staff meetings were used to sustain staff interest and stimulate memory.

Staff anecdotal impressions of the study ranged widely from thinking that the process was too timeconsuming and lacked meaning, to discovering that the outcome label and indicators really helped describe what the nurse assesses when taking care of a cardiac intensive care patient.

CONCLUSIONS

Through being more familiar with NOC, the staff is determining which outcomes comprise core nursing‐sensitive outcomes that reflect the type of nursing care given in an ICU. Two new outcomes regarding the ventilator weaning process were developed. These have been submitted to the University of Iowa for consideration.
The Use of NANDA, NIC, and NOC in the Identification and Measurement of Problems, Interventions, and Outcomes in Spinal Cord Injury
Authors: Hughes Rodney
Published: August 2004

PURPOSE

To ascertain the possibility of identifying problems experienced by patients with spinal cord injury that are addressed by specific and independent nursing decisions and actions.

METHODS

A two‐part study was undertaken. Part 1 used the Delphi method with an expert panel of nurses from the 11 spinal cord injury facilities in the U.K. to gain a consensus on presenting patient problems, patient problems with which nurses had major input into resolution, planned patient outcomes for those problems, and interventions undertaken to address the problems in order to achieve the outcomes. NANDA, NIC, and NOC classifications were used to assist the expert panel in defining the problems, interventions, and outcomes identified.

Part 2 was an analytic and evaluative, prospective, longitudinal cohort study using participant observation to test empirically the findings of the Delphi study. The care experiences of patient cohorts from two spinal cord injury facilities in the U.K. were examined to see if the patient problems addressed by nurses were identified, whether planned outcomes for those problems were identified, and what interventions were used to address those problems. Linkages were sought among the problems, interventions, and outcomes.

FINDINGS

There was general consensus on the patient problems, interventions, and planned outcomes addressed by specific nursing decisions and actions. There was a high level of agreement with the definitions of the problems using NANDA, the definition of the planned outcomes using NOC, and the nursing interventions using NIC. It was possible empirically to attribute patient outcomes for specific problems to the nursing interventions undertaken.

DISCUSSION

The study demonstrated that it is possible — in these times of multi‐, inter‐, and intradisciplinary approaches to care—to identify the contribution a single profession makes to the total care process. It may also be desirable to identify and measure the contribution a particular profession makes to patient outcomes because only thus can the value of the contribution be recognized. Also, the methods used allowed an assessment of outcomes to be undertaken without having to use a randomized control trial.

CONCLUSIONS

The study demonstrated both theoretically and empirically that the use of standardized nursing languages can help clarify nursing concepts underlying care processes in patients with spinal cord injuries. If problems, and the actions taken by nurses to address those problems, are identified, those actions can lead to outcomes that can be attributed to nursing activities. The use of standardized nursing languages illuminated aspects of nursing care that are at present hidden.
Use of NANDA, NIC, and NOC as a Framework for Cyclic Perimenstrual Pain and Discomfort
Authors: Killeen Mary B.
Published: August 2004

BACKGROUND

Since its formation in 1969, the Association of Women's Health and Obstetric and Neonatal Nursing (AWHONN) has strongly promoted excellence in nursing practice. This commitment to excellence is demonstrated by AWHONN's Research‐Based Practice Project. This program involves gathering research and studies performed in a particular area and developing and testing an evidence‐based guideline that can be readily incorporated into the nurse's daily practice.

The organizing framework of standardized nursing language using the specific standardized nursing languages of NANDA, NIC, and NOC (NNN) was added in this fifth AWHONN Research‐Based Project, “Cyclic Perimenstrual Pain and Discomfort (CPPD).” Based on the literature, evidence, and science, an assessment and data collection process was developed and tested in five sites with a final sample of 230 subjects.

MAIN CONTENT POINTS

No other national guideline work using an evidence‐based approach has integrated NNN into the structure and documentation of a clinical practice guideline. The decision to incorporate NNN as the project's framework was based on a good fit between the goals of the project and the usefulness of standardized nursing language. The project goals were to (a) identify the problem with a “quick screen” tool, (b) provide assessment strategy to determine parameters of pain and symptoms, (c) implement a nursing plan of care or referral, and (d) evaluate the intervention for effectiveness.

Benefits of using standardized nursing language include (a) use of a common language for nursing practice by basic and advanced RNs in all settings, (b) complete and consistent documentation, (c) streamlined paper system using SNL with user satisfaction as a necessary precursor to a viable computerized paper record, and (d) potential for costing of nursing care and reimbursement for nursing services using standardized documentation and cross mapping with major clinical databases and reimbursement codes.

The evidence‐based documentation forms and aids for assessment, diagnosis, expected outcomes, planned and actual interventions, and evaluation of actual outcomes were developed with the assistance of clinical site coordinators and tested in practice. Labels and definitions of NICs and NOCs were not changed. NIC activities were referred to in the forms as “Intervention Activities for Cyclic Perimenstrual Pain and Symptoms.” The final practice guideline is available for purchase at http://www.AWHONN.org.

CONCLUSIONS

The NNN framework as an organizing structure was evaluated favorably for usefulness. CPPD was found to be a very complex health problem with many variables requiring sound assessment and individualized planning. The most important implication for practice is the need for computerized charting integrated into the flow of the practice setting to properly implement the use of the evidence‐based practice forms.
Use of NANDA, NIC, and NOC in Infection Control
Authors: Lippens Beth
Published: August 2004

BACKGROUND

The elderly are at increased risk for infections due to increased age and debilitated conditions. Two of the most frequent infections are urinary tract infections and respiratory infections. These often routine infections in a geriatric resident can result in potentially life‐threatening complications. Tracking and preventing infections in long‐term care facilities is essential in maintaining residents' quality of life and assisting them to function at their highest practicable level. Federal and state regulations require the presence of an infection‐control program in long‐term care settings to prevent the development and transmission of disease and infection within the facility.

MAIN CONTENT POINTS

By incorporating NANDA, NIC, and NOC into the infection‐control program, staff members were able to create an infection‐specific, shortterm plan of care for infections with minimal time requirements. The nursing diagnosis used for this example was risk for infection followed by the NIC “infection protection” and the NOC Infection Status. Outcomes appropriate for the infection were chosen from the outcome category Infection Status. Scores of 1 (severe) through 5 (none) were listed beside each intervention chosen. The resident's symptoms were rated at the onset of infection, at intervals during treatment, and at the conclusion of treatment using the 1–5 scale. The ratings reflected the improvement of symptoms as treatment progressed. If no improvement was seen, reevaluation and further treatment were initiated.

CONCLUSIONS

Measurement of resident outcomes to indicate appropriate nursing interventions is vital in determining proper treatment in long‐term care residents. Use of standardized nursing language can facilitate nursing care.
NANDA and NIC: Mediators to Describe Irish Intellectual Disability Nursing
Authors: Sheerin Fintan
Published: August 2004

PURPOSE

To identify the foci of interest specific to nursing interventions within residential, intellectual disability nursing through the use of the terms and meanings presented in NANDA and NIC.

METHODS

Data were collected using a Delphi approach involving a purposive sample of 8 individuals with relevant expertise, followed up by the conduct of three focus groups held with a total sample of 17 intellectual disability nurses working in three Irish service settings: traditional residential, community residential, and nurse education. Data were examined for contextual meaning as well as consensus of perceptions.

FINDINGS

Many potential interventions and diagnoses were identified for the field of residential learning disability nursing. Interventions that elicited a >50% consensus among participants across groups were examined for contextual meaning, based on the taped and noted responses, and potentially related NIC interventional labels were then applied. These led, through a reverse NIC‐NANDA linkage exercise, to the identification of 8 potentially related interventions. The contextual aspect directed the analysis process to identify the nursing diagnoses associated with the interventions to be used, and 21 resultant diagnoses were identified.

DISCUSSION

Further analysis and study are needed to verify the relevance of these diagnoses and interventions to residential learning disability. A quick comparison of the results with those of studies carried out in other countries demonstrates that certain diagnoses have been identified by one or more authors in their studies.

CONCLUSIONS

This study identified a number of foci that have achieved various levels of consensus among the study participants. The ongoing study plan will further examine nurses' and managers' perceptions while also looking at these within the context of current service philosophy.
Nursing Diagnoses in Psychiatric Acute Wards in Switzerland and Austria
Authors: Stefan Harald , Grywa Diana , Abderhalden Christoph , Faust Anna Margarethe , Needham Ian , Quiblier Ursula , Willard Werner
Published: August 2004

PURPOSE

To examine the frequency and quality of documented nursing diagnoses and to compare the diagnoses regarding ward and patient characteristics.

METHODS

The following data were collected from 11 acute care wards in five psychiatric hospitals in Switzerland and Austria: documented nursing diagnoses, demographic characteristics of an unselected sample of 30 consecutively discharged patients in each ward, ward data, and data from three randomly selected complete charts from each ward. Free‐text diagnoses were recoded into NANDA terminology. Frequencies were calculated and compared across settings and regarding patient and ward characteristics. Diagnoses were examined for quality and structure of the diagnostic statements.

FINDINGS

Mean age of patients was 40 ± 13 years, and the main psychiatric diagnoses were schizophrenia, mood disorders, substance abuse, and neurotic and personality disorders. Of the 664 nursing diagnoses located in 330 nursing records, 635 were proper nursing diagnoses; 83% of patients had at least 1 nursing diagnosis (X̄= 2). The number of diagnoses correlated weakly with patient length of stay. Of the nursing diagnoses, 20% were made on admission day, and the majority of nursing diagnoses was active at discharge. Ninety percent of the diagnoses were formulated using NANDA terminology. The most frequently used categories were coping‐related diagnoses—disturbed thought processes and self‐care deficits. Numerous problem–etiology–symptom (PES)formatted diagnoses had diagnostic labels nested within the etiology. Countryand setting‐specific similarities and differences were found with a significantly higher number of nursing diagnoses in Austria where use is mandated. In Austria, more somatic nursing diagnoses were found. The most frequent nursing diagnoses were similar in both countries.

DISCUSSION

The number of diagnoses corresponds to results reported in the international literature suggesting the justification for international comparison. Ten categories represent 60% of nursing diagnoses. Approximately 50% of nursing diagnoses were made in the first days after hospitalization, rendering their use practicable. A minority of nursing diagnoses were discontinued, possibly suggesting that some problems are difficult to solve or evaluate. The PES format and the NANDA terminology are used quite extensively even when not mandatory. NANDA terminology is deemed useful and practical, but problems occur when nursing diagnoses

CONCLUSIONS

Nursing diagnoses represent the main areas of nursing, but cultural differences exist regarding the diagnostic process. Thus, research is needed to test the appropriateness of nursing diagnoses to characterize nursing populations.
Validation of Dysfunctional Ventilatory Weaning Response
Authors: Perry Anne G.
Published: August 2004

PURPOSE

To further clinically validate the defining characteristics of dysfunctional ventilatory weaning response (DVWR) in patients requiring long‐term mechanical ventilation.

METHODS

The Weaning Readiness Assessment Scale (WRAS), a 28‐item, 60‐point scale used to assess patients' readiness to wean from mechanical ventilation, was used to collect data on a large data set of 533 patients who were on mechanical ventilation >4 days. Data were collected every other day until the patient was weaned, discharged, or expired. The WRAS is comprised of two subscales: the physiological/behavioral (PPBB) subscale and ventilatory subscale (VVV).

FINDINGS

A content validity index of 0.88 indicated that the variables and their scoring ranges were appropriate for the study population. Interrater and test‐retest reliability measures were 0.93 and 0.92, respectively. Internal consistency (Cronbach's alpha, p<0.05) for the PPBB and VVV subscales were .69 and .76, respectively. Data were available on 533 subjects and analyzed by principal component extraction with varimax rotation, resulting in a two‐factor solution with strong loadings for 17 variables. In addition, preliminary one‐way analysis of variance showed statistical significance (p<0.05) on these 17 variables. Where statistical significance was not present, the trend was in the expected direction.

DISCUSSION

These data imply that 10 of the 17 variables alone and in combination affect weaning from mechanical ventilation and lend support to the existing defining characteristics of DVWR. In addition, data revealed 7 statistically significant symptom variables affecting weaning from mechanical ventilation that are currently not listed as defining characteristics for DVWR: need for multiple vasopressors, fluid overload, multiple antibiotic use, bronchodilator use, need for high FiO2, and high PEEP levels.

CONCLUSIONS

For most patients, weaning from mechanical ventilation is a smooth transition. Patients who require >3 days of mechanical ventilation are an expensive patient population for acute care hospitals. Forty percent to 42% of mechanically ventilated patients either fail the initial spontaneous breathing trial (24%) or are extubated and require reintubation (16%–18%). The weaning process for long‐term mechanically ventilated patients has fiscal and psychosocial ramifications for the patient, family and friends, and healthcare providers.
The Conceptual Development of Dependence, Independence, and Interdependence as Potential Nursing Diagnoses
Authors: Anderson Whiting Sylvia M. , Whiting Judith A.
Published: August 2004

BACKGROUND

A Delphi study was completed in 1992. In the interim, sample statements were used to begin development of a questionnaire for ultimate testing of the concepts of dependence, independence, and interdependence. The statements have been used over several years in questionnaires given to students, adults in church groups, and individuals from a clinical cohort who have been in therapy with one of the authors. Certain statements are being considered for deletion because they may not be mutually exclusive; they will remain part of the questionnaire, however, until testing is completed.

MAIN CONTENT POINTS

Dependency is well described as a disorder in psychiatric literature; however, the concept should be considered for inclusion in the nursing nomenclature. No attention has been given to independence as a disordered state of being, and interdependence has not been included in the nomenclature even though the term is frequently used in nursing literature to describe interactions between people.

Nurses have long taken care of clients with problems of dependency or independence; however, while dependency has constituted a major focus of caregivers, independence has been ignored since it has traditionally been conceived of as a healthy behavior only. Clients often present with what is being termed defensive independence as opposed to dysfunctional independence. Interdependence is considered to be a healthy state of being and may be a way of defining strengths, depending on the degree to which it is demonstrated in given individuals. Recognizing that people tend to lack objectivity about themselves, a companion questionnaire is in development for use with spouses, partners, or any who have a close relationship with the client. The items are matched but are written as “My spouse/friend….”

CONCLUSIONS

The client questionnaire will lend itself to research by clinical nurse specialists or nurse practitioners who work with clients having relationship problems.
Describing Professional Nursing Through a Universal Record in Perioperative Settings
Authors: Beyea Suzanne C.
Published: August 2004

PURPOSE

To establish professional nursing practice standards for perioperative documentation in order to provide clinicians and software developers with a national model for perioperative documentation.

METHODS

The sample consisted of paper and computerized records representing clinical practice settings from for‐profit, nonprofit, and government agencies. Facilities ranged in size from 45–>900 beds and performed, on average, 500 surgeries each month. Intraoperative records ranged from 1–7 pages.

A national sample of more than 150 perioperative records representing both inpatient and ambulatory settings were collected and analyzed to identify common data elements. Data elements that represented the intraoperative period were noted, using a structured format. Two expert nurses conducted the analysis and achieved a high level of interrater reliability when coding the clinical records.

FINDINGS

This analysis uncovered a disappointing reality about the current status of intraoperative nursing documentation. One major finding included the marginal consistency in the collection of structural data elements (e.g., start time, stop time, anesthesia type, wound classification). Also, nursing diagnoses, interventions, and patient outcomes were documented in fewer than 22% of the records.

CONCLUSIONS

In surgical settings, the professional aspects of intraoperative nursing care are embedded in the care delivered and not accurately or fully represented in clinical documentation. To understand the contributions of perioperative nurses to surgical outcomes, the framework for documentation must be structured in a manner that includes nursing diagnoses, interventions, and outcomes. The benefits of structured vocabulary can only be fully realized when national documentation standards are established and implemented within and across settings. This effort resulted in the development of a best practice model for a nursing preoperative assessment and intraoperative documentation that has been adopted by clinicians and software developers.

Professional nurses must document the care they provide in a manner that represents the professional aspect of their care. Nursing contributions cannot be fully evaluated unless they are represented and documented in clinical records. The use of structured vocabulary may assist nurses to accept and utilize standardized terms, but the most important factor is a nursing record that fully represents and describes professional nursing practice. The ability to computerize clinical records will not help in evaluating the effectiveness of nursing practice unless assessments, identified problems, interventions, and outcomes are consistently and appropriately documented.
Integrating Nursing Acuity, NANDA, NIC, and NOC Into an Automated Nursing Documentation System
Authors: Frederick Julie , Watters Mary
Published: August 2004

BACKGROUND

The goal of this project was to have nursing documentation drive acuity in a seamless fashion. The success we have encountered was building our framework with standardized nursing language, integrating our stable patient classification system into the framework, and enclosing them online in the computer documentation system.

MAIN CONTENT POINTS

Nursing documentation with NIC and NOC drives the acuity system. Acuity mapping is integrated into the automated nursing documentation system.

CONCLUSIONS

Our success in integrating nursing acuity, NANDA, NIC, and NOC into an online nursing documentation system has been monumental. The healthcare team's documentation can truly identify the patient's needs and provide the necessary acuity to make appropriate assignments, staff according to skill level requirements, and charge patients accurately. The journey from online documentation to integrating NANDA, NIC, and NOC into an online acuity system is just a start in identifying nursing best practices and efficient and effective patient outcomes. Continued research will prove exciting and lead the institution into the next step of patient outcome successes.
Nursing Care Documentation Using NANDA, NIC, and NOC
Authors: Johnson Carole
Published: August 2004

BACKGROUND

Professional nurses worldwide are concerned as we struggle to communicate and document what a nurse actually does, and how nursing decisions and actions contribute to the care component of health care. Nurses are confident that their actions affect patient care quality through improved patient outcomes, but data collection is the only way to defend this position. To enable nurses to contribute to these data, we need to expose them to the new languages in a pragmatic rather than theoretical format. Nurse‐friendly documents must be made available to assist the practitioner to assimilate the new languages into the daily practice of nurses who work with and care for real clients.

MAIN CONTENT POINTS

This tool, organized according to the NIC taxonomy, begins appropriately with patient assessment and guides the nurse to courses of action that increase the probability of producing effective outcomes. As suggested interventions reflect current nursing practice gathered from expert clinicians in most specialties, the learning curve is not overwhelming.

CONCLUSIONS

While this document focused on the elderly, the format can be adapted for any patient population by a facility's expert clinicians, who would choose the most appropriate interventions and outcomes for the population served.
Applying Standardized Nursing Language to Three Cardiac and Pulmonary Rehabilitation Programs in a Rural Setting
Authors: Ahern Cathleen K.
Published: August 2004

BACKGROUND

The need for travel between rural and tertiary hospitals for cardiopulmonary services is a reality many patients experience. Communication between hospitals is essential in providing the most effective and efficient patient care. This work involved incorporating NANDA, NIC, and NOC into standard care plans and the ongoing documentation expansion for the care of an outpatient cardiopulmonary population.

MAIN CONTENT POINTS

This regional project involved cardiopulmonary rehabilitation programs from three Mayo Health System affiliates. Acute care had begun to use NANDA, NIC, and NOC for computerized documentation. Cardiopulmonary services realized the benefits of following acute care's lead in applying standardized nursing language to outpatients. The project was undertaken to enhance communication across the care continuum.

Pertinent NANDA nursing diagnoses, NIC interventions, and NOC outcomes were identified, a process that invoked the discussion of the commonalities and differences among the three taxonomies. This became beneficial in benchmarking the different program structures and gleaning best practices. Through much discussion the care plans were developed with subsequent revisions as necessary.

Issues surrounding the project included getting used to the terminology and computerization, getting bogged down in the details, trusting each other with information about programs, building a group cohesiveness, seeing timely results of our efforts, and communication among sites.

CONCLUSIONS

Benefits realized through this project were strengthening the comprehensiveness of the plan of care for cardiopulmonary patients and computerizing the patient record. Through this process the interdisciplinary cardiopulmonary practice was better defined. Communication was strengthened because standardized nursing language took the “fuzz” out of communication between providers and across the care continuum. Another outcome included establishing trust and collegiality among the three sites for future networking and problem solving. Outcomes data can be used to test the effectiveness of nursing interventions for the improvement of patient care. This research should encompass studying the effectiveness of care provided within the programs as well as across the care continuum.
Estimated Time and Educational Requirements to Perform NIC Interventions
Authors: Bulechek Gloria M. , Dochterman Joanne McCloskey
Published: August 2004

PURPOSE

To estimate the time to perform and type of personnel to deliver each of the 486 interventions listed and described in the third edition of NIC.

METHODS

Small groups of research team members rated selected interventions in their area of expertise on education and time needed for each intervention. Education needed was defined as the minimal educational level necessary to perform the intervention in most cases in most states. Rating categories were (a) nursing assistant (NA/LPN/LVN/technician), (b) RN (basic education whether baccalaureate, associate degree, or diploma), or (c) RN with post‐basic education or certification. Time needed was defined as the average time needed to perform the intervention. Raters selected one of five possible time estimates: (a) <15 minutes, (b) 16–30 minutes, (c) 31–45 minutes, (d) 46–60 minutes, or (e) >1 hour. All ratings were reviewed across groups to ensure overall consistency.

FINDINGS

Results of this exercise provide beginning estimates of the time and education needed for 486 NIC interventions. Twenty percent required <15 minutes, 30% required 16–30 minutes, 17% required 31–45 minutes, 12% required 46–60 minutes, and 21% required >1 hour. More than 70% of the interventions were judged as needing basic RN education to perform. Raters judged RN post‐basic education to be required to performi 16% of the interventions, and 14% were deemed appropriate for personnel with NA/LPN education to perform. A monograph, Estimated Time and Educational Requirements to Perform 486 Nursing Interventions, available from http://www.nursing@uiowa.ed/cnc, includes lists of interventions appropriate for each time and education category, as well as time and education ratings according to NIC domains and classes.

DISCUSSION

The estimates of time and education provided by expert ratings provide a good beginning for cost estimates, resource planning, and reimbursement. The results of this study add to the small but growing body of literature that demonstrates that estimates of time to perform interventions by nurses who are familiar with the interventions is an accurate and efficient method to determine time values. A description of how this information can be used in a costing model is in the July/August 2001 issue of Nursing Economics.

CONCLUSIONS

NIC has identified the interventions that nurses perform. This study of time to perform and type of personnel to deliver each of the NIC interventions can help nurse leaders make better‐informed decisions about cost‐effective nursing care.
Use of NANDA, NIC, and NOC in a Baccalaureate Curriculum
Authors: Finesilver Cynthia , Metzler Debbie
Published: August 2004

BACKGROUND

For the last 8 years, NANDA, NIC, and NOC have been successfully introduced to students in fundamentals courses at Bellin College of Nursing. As students progress through the curriculum, the classifications are expanded and applied to various client populations in all settings. The faculty expect students to use NANDA, NIC, and NOC in a variety of ways: during preparation for care of clients, documentation of client care, discussion of clients in postconference; in formal nursing process papers; and in the college laboratory setting.

MAIN CONTENT POINTS

Through the use of standardized languages, which address all steps of the nursing process, students have been able to plan, implement, and evaluate nursing care in all settings, from primary care to specialty care areas. Application of the NANDA, NOC, and NIC frameworks into a baccalaureate curriculum is desirable because the classifications are research based, comprehensive, and based on current nursing practice. NOC and NIC include physiologic, psychosocial, illness prevention and treatment, health promotion, and alternative therapies. Because of the universal and clinically meaningful language, students are able to communicate and document nursing activities in diverse settings and better define the unique actions and value of nursing.

Feedback from students and faculty has been positive. Faculty members are encouraged to refine and alter course expectations related to NANDA, NOC, and NIC as needed. Students in the fundamentals courses adapt easily to NANDA, NOC and NIC during small group work and during discussion of common client problems, such as constipation.

CONCLUSIONS

Although the frameworks are not used as part of the organizing framework, they are used to teach nursing process and increase students' critical thinking and problem‐solving capabilities.