THE RELATIONSHIP OF THE TAXONOMY "CONDITIONS THAT NECESSITATE NURSING CARE" IN RELATION TO OUTCOMES IN THE CARDIOVASCULAR SURGICAL PATIENT (NURSING).
Contributors: Case Western Reserve University.
Published: 1991
Number of pages: 278
Subjects: Health Sciences, Nursing.; Health Sciences, Medicine and Surgery.
Description: The purposes of this study were to examine (a) quality of care by relating the process of care to patient outcomes and (b) the usefulness of the nursing diagnoses taxonomy, "Conditions that Necessitate Nursing Care" (CNNC) in predicting outcomes. Process of care is reflected by nursing diagnoses (NDx), the aggregation of NDx into CNNC taxonomic categories and the total incidence of NDx. The CNNC categories called Human Response Patterns (HRP) were Communicating, Choosing, Exchanging, Feeling, Knowing, Moving, Perceiving, Relating and Valuing. The patient outcomes of care were survival, length of stay (LOS), functional health status (FHS) and quality of life (QOL).

Using a prospective repeated measure design, 116 subjects hospitalized for coronary artery bypass graft surgery were recruited for study participation; 91 subjects continued in this study 4 weeks after discharge. The assigned nurse identified the NDx at four phases of hospitalization: before surgery (independence phase), within 24 hours of surgical intensive care unit (SICU) admission (somatic phase), within 24 hours of transfer from SICU (transition phase) and within 24 hours of discharge (resolution phase). Subjects completed a survey questionnaire containing: the Katz Activities of Daily Living (ADL), Instrumental Activities of Daily Living Index (IADL), and Ferrans and Powers Quality of Life Index (QLI). The Cronbach alpha for the ADL and IADL, and QLI was.80 and.95 respectively.

Results showed that anxiety and knowledge deficit were salient NDx regardless of hospitalization phase, and risk of infection, pain and altered skin integrity were important after surgery. Multiple regression analysis revealed that the HRP Relating was the best predictor of hospital LOS during the transition phase. The HRP Relating was the best predictor of QOL after discharge during the independence phase. Using discriminate function analysis, the HRP Exchanging, Feeling, and Valuing with history of chronic health distinguished between subjects dependent in ADL and not dependent in ADL with an 81.2% accuracy rate. This study illustrated that taxonomic structures of NDx can target populations at risk or for intervention. The possibilities for future exploration comparing alternative taxonomic structures with outcomes, designing interventions specific to outcomes and contrasting trajectories of patient's need for nursing across populations, hospital systems and countries are exciting.
Notes: Source: Dissertation Abstracts International, Volume: 52-10, Section: B, page: 5192.

Thesis (PH.D.)--CASE WESTERN RESERVE UNIVERSITY (HEALTH SCIENCES), 1991.

School code: 0499.