bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fatigued Elderly Patients With Chronic Heart Failure
Authors: Ehrenberg Anna , Ekman Inger 
Published: August 2004

PURPOSETo 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.METHODSPatients 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.FINDINGSTiredness 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.DISCUSSIONSymptoms 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.CONCLUSIONSFindings 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

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

BACKGROUNDNursing 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 POINTSTwo 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.CONCLUSIONSThrough 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

PURPOSETo ascertain the possibility of identifying problems experienced by patients with spinal cord injury that are addressed by specific and independent nursing decisions and actions.METHODSA 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.FINDINGSThere 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.DISCUSSIONThe 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.CONCLUSIONSThe 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

BACKGROUNDSince 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 POINTSNo 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.CONCLUSIONSThe 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

BACKGROUNDThe 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 POINTSBy 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.CONCLUSIONSMeasurement 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

PURPOSETo 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.METHODSData 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.FINDINGSMany 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.DISCUSSIONFurther 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.CONCLUSIONSThis 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

PURPOSETo examine the frequency and quality of documented nursing diagnoses and to compare the diagnoses regarding ward and patient characteristics.METHODSThe 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.FINDINGSMean 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.DISCUSSIONThe 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 diagnosesCONCLUSIONSNursing 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

PURPOSETo further clinically validate the defining characteristics of dysfunctional ventilatory weaning response (DVWR) in patients requiring long‐term mechanical ventilation.METHODSThe 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).FINDINGSA 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.DISCUSSIONThese 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.CONCLUSIONSFor 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.