PRIORITIZING NURSING DIAGNOSES.
Contributors: Boston University.
Published: 1985
Number of pages: 164
Subjects: Health Sciences, Nursing.
Description: Using an instrument designed for this study, "Questionnaire on Prioritization of Nursing Diagnoses," sixty registered nurses from medical-surgical units of two greater Boston teaching hospitals made 2087 judgments and produced a priority listing of diagnoses. The instrument contained nursing diagnoses with related case descriptions arranged in pairs. Out of each pair, nurses were asked to select the patient most in need of treatment. The four diagnoses chosen as having the highest priority were: alteration in cardiac output related to impaired myocardial function; alteration in comfort (pain) related to epigastric distress; potential fluid volume deficit related to alteration in normal intake and output; and respiratory distress related to ineffective breathing pattern. The four diagnoses chosen as having the lowest priority were: altered tissue perfusion related to interrupted peripheral venous flow; impaired physical mobility related to neuromuscular dysfunction; total self care deficit related to cognitive impairment; and nutrition alteration, less than body requirements, related to inability digest and/or absorb nutrients. When the sample was analyzed according to educational background and years of experience, the top four priorities were retained across all groups. The lowest priorities had some variation but were very similar.

In addition, using priority setting models found in the literature, nurse educators determined rationales for the priority listing selected by respondents. Rationales for prioritizing diagnoses were in the following descending order: problem oriented model, physiological needs (Maslow's model, need I), safety/security needs (Maslow's model need II), and CPR model (concern over airway, breathing, and circulation). It was noted that the acuity of a patient's physiological and safety needs was of paramount importance.

Recommendations for further research were to refine the instrument for clarity, reliability and validity, and extend the study by including psychosocial diagnoses in the instrument and by using a larger sample. Further investigation regarding the variables of treatment time and nursing skill should be done. Other research should be conducted on developing more precise terminology, standardizing diagnostic subcategories, and combining nursing diagnoses with Patient Classification Systems. Nursing textbooks should also be revised to incorporate nursing diagnoses, and teaching modules should be developed using this study's rationales for prioritizing diagnoses.
Notes: Source: Dissertation Abstracts International, Volume: 46-11, Section: B, page: 3783.

Thesis (ED.D.)--BOSTON UNIVERSITY, 1985.

School code: 0017.