Nursing Diagnosis Research: Computer-Aided Research in Nursing

The authors describe the development of a research tool for studies on nursing diagnosis by the Computer-Aided Research in Nursing (CARIN) project. The tool, a computerized assessment guide, has reliable and valid items for the identification of patient problem areas. The patient information in the assessment guide, nursing diagnoses identified by the clinical nurse specialist, and a statistical interface are linked in a customized computer program for the CARIN project, providing a system capable of analyzing patient problems from several perspectives. The system provides an accurate assessment and subsequent analysis of patient problems, as well as large data sets. Implications for the future of nursing diagnosis research are discussed.     

Accuracy and Efficiency of Computer‐Aided Nursing Diagnosis

PURPOSE. This study aims to determine whether a computer‐aided nursing (CAN) diagnosis system improves diagnostic accuracy and efficiency. METHODS. A randomized crossover trial was performed using two kinds of case studies with 42 nurses as subjects. The subjects were divided into a group using the CAN diagnosis system and a group using a handbook of nursing diagnosis. Degree of accuracy was judged by using Lunney's seven‐point interval scale, while efficiency was evaluated by time required for diagnosis. FINDINGS. There was no significant difference between the two groups in terms of diagnostic accuracy; however, time required for diagnosis was significantly shorter for subjects who used the CAN diagnosis system than for those who did not. Multiple regression analysis showed that the use of the CAN diagnosis system was the only factor associated with the time required for making the nursing diagnosis. CONCLUSIONS. The use of the CAN diagnosis system improved the efficiency of the diagnostic process without reducing the level of accuracy of nursing diagnoses. PRACTICE IMPLICATIONS. The use of a computerized system should be a useful tool for implementation of standardized nursing terminologies.     

Mixed Incontinence: A New Nursing Diagnosis?

Consistent efforts to identify and clinically validate new nursing diagnosis within recognized categories are essential to taxonomy development. Mixed incontinence is a clinical condition resulting in leakage of urine associated with increased intra-abdominal pressure (stress) and inability to delay voiding (urge). The presence of mixed incontinence was clinically validated in two populations (n = 9, n = 40) of community-dwelling women and initial defining characteristics were identified. Research findings from both studies support the addition of a proposed sixth nursing diagnosis, mixed incontinence , to the diagnostic category, alteration in urinary elimination.     

Nursing Diagnosis: The Importance of a Definition

Nursing as an evolving science entertains the usage of terminology that lacks clarity and the singular application of terms. The resulting semantic confusion leads to difficulty in operationalizing definitions for use in taxonomic efforts and in research. Examples of this confusion exist where the term nursing diagnosis is used as concept, category, process, and product. Four suggestions are made to alleviate these difficulties.     

An Evaluation Guide to Assist with Implementation of Nursing Diagnosis

Nursing diagnosis is increasingly recognized as an integral component of professional nursing practice. Implementation of nursing diagnosis impacts on all elements of professional practice: the philosophy, purpose, and objectives of an organization; care planning; quality assurance; staff education; performance standards; the nursing care delivery system; documentation; and patient classification. A guide organized around these elements has been developed to assist with the implementation of nursing diagnosis. This guide can be used to gather information to plan for the implementation of nursing diagnosis or as a post-test to judge the success of the implementation process.     

Predicting Violence: Nursing Diagnosis Versus Psychiatric Diagnosis

Predicting violent behavior is a major concern for nurses as well as other mental health professionals. Two diagnostic assessment systems (Nursing Diagnosis-NANDA and Psychiatric Diagnosis- DSM III-R ) were compared in their ability to predict assaultive behavior. The nursing diagnosis potential for violence suggested a difference ( p = .07) between the assaultive and control subjects. No differences were found between assaultive and control subjects on psychiatric diagnoses. Nursing diagnosis is based upon measurable behaviors and is time specific. Clinical implications and further research endeavors in this area are suggested.     

护理诊断在内科患者临床护理实践中的应用

目的探讨护理诊断在内科患者的临床护理实践中的应用效果。方法按随机数字表法将2011年5月至2012年7月解放军72495部队郑州干休所卫生所收治的140例内科患者分为观察组和对照组各70例,对照组患者实施常规护理,观察组患者在对照组的基础上实施护理诊断,评价并比较两组患者的护理满意度。结果观察组患者的满意度显著高于对照组,两组比较,差异有统计意义(P0.05)。结论护理诊断应用于内科患者的临床护理实践中,有利于提高患者满意度,值得在临床推广应用。     

Accuracy and Efficiency of Computer-Aided Nursing Diagnosis

PURPOSE.  This study aims to determine whether a computer-aided nursing (CAN) diagnosis system improves diagnostic accuracy and efficiency.
METHODS.  A randomized crossover trial was performed using two kinds of case studies with 42 nurses as subjects. The subjects were divided into a group using the CAN diagnosis system and a group using a handbook of nursing diagnosis. Degree of accuracy was judged by using Lunney's seven-point interval scale, while efficiency was evaluated by time required for diagnosis.
FINDINGS.  There was no significant difference between the two groups in terms of diagnostic accuracy; however, time required for diagnosis was significantly shorter for subjects who used the CAN diagnosis system than for those who did not. Multiple regression analysis showed that the use of the CAN diagnosis system was the only factor associated with the time required for making the nursing diagnosis.
CONCLUSIONS.  The use of the CAN diagnosis system improved the efficiency of the diagnostic process without reducing the level of accuracy of nursing diagnoses.
PRACTICE IMPLICATIONS.  The use of a computerized system should be a useful tool for implementation of standardized nursing terminologies.     

Nursing Diagnosis at Work: From Metaphors to Nursing Diagnoses

Nursing Diagnosis at Work shows that nursing diagnosis is alive, well, and at work in clinical settings. As they strive to enable nurses and nursing students to use data sets to make inferential decisions, the nursing faculty at Southeastern Louisiana University found an innovative source as a data set. Two faculty members describe one of the strategies they use to make nursing diagnosis work for their students. If you have identified another well-known data set, please share it and the way you have used it. MKMJ.     

Coining and Defining Novel Nursing Terminology. Part 1: Critical Incident Nursing Diagnosis

PURPOSE.  In the first of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the North American Nursing Diagnosis Association (NANDA) International Classification—Critical incident nursing diagnosis (CIND)—defined as the recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication.
DATA SOURCES.  The literature, research studies, and meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article.
DATA SYNTHESIS.  The current nursing diagnoses in the NANDA International Classification are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations.
CONCLUSIONS.  Coining and defining a novel nursing terminology, CIND, for patient care during life-threatening situations are important and fill the gap in the current standardized nursing terminology.
IMPLICATIONS FOR NURSING PRACTICE.  Refining the NANDA International Classification will permit nursing researchers, among others, to conduct studies on nursing diagnoses in conjunction with the proposed novel nursing terminology: CIND. Parts 2 and 3 of this series will propose additional nursing terminology: critical incident nursing intervention and critical incident control, respectively.     

Nurse Practitioners' Use of Nursing Diagnosis

The role of the nurse practitioner (NP) represents a unique blend of nursing and medical functions. Few studies exist that address the nursing component of the NP role and no literature is available to document the extent to which nurse practitioners utilize nursing diagnoses in their clinical practice. Thus, the author reports findings of a study that sought to describe the use of nursing diagnosis in current NP practice and to identify advantages and barriers to the use of nursing diagnoses by NPs. Fifteen percent of nurses surveyed used nursing diagnoses in their practice. The diagnoses most commonly used reflected attention to clients' lifestyles and daily living problems.     

A Trifocal Model of Nursing Diagnosis: Wellness Reinforced

As nurses have identified the phenomena of concern to nursing and developed diagnostic language, there has been a persistent omission of diagnostic labels that reflect health and a wellness orientation. The fact that the term "diagnosis" has been identified with problems and deficits has impeded work on wellness diagnoses. Further, lack of consensus regarding a definition of health further complicates work in this area. The authors propose a model that incorporates a category of "opportunity to enhance," in addition to the categories of "problem" and "high risk" to derive a trifocal model of nursing diagnoses. Examples from nursing practice are given.     

Dyspnea: A Case for Nursing Diagnosis Status

Dyspnea, the unpleasant subjective sensation of difficult breathing, is one of the most common symptoms experienced by patients with pulmonary and cardiac disorders. This article reviews the research concerning dyspnea and proposes it for consideration as a nursing diagnosis. The etiologies are categorized according to the neurosensory, neurochemical, cognitive, and affective mechanisms. The defining characteristics include the subjective words describing dyspnea, such as shortness of breath, suffocation, and tightness. The most supported objective sign of dyspnea in the literature is an increased use of accessory muscles of respiration. Nursing interventions for dyspnea relief are geared toward reducing the afferent activity from receptors in the respiratory muscles and dealing with the affective component of dyspnea. These interventions include pacing activities, breathing techniques, and inducing the relaxation response. Because most research for interventions to reduce dyspnea have focused on patients with obstructive lung disorders who have chronic dyspnea, recommendations for further research include using acutely ill patients and those with a variety of medical conditions.     

Hypothermia: One Nursing Diagnosis or Three?

The nursing diagnosis of hypothermia has been described by various authors as having multiple defining characteristics. A major problem identified was a lack of consistency on an exact temperature value for this nursing diagnosis. A review of the literature on hypothermia showed three distinct types of hypothermia: inadvertent, accidental, and intentional. Each of these types were distinguished by etiologies and defining characteristics and are presented using the hypothetic model case approach.     

NANDA's Definition of Nursing Diagnosis: A Plea for Conceptual Clarity

A working definition of nursing diagnosis was adopted by the North American Nursing Diagnosis Association (NANDA) Biennial Business Meeting in March 1990. Because of the working nature of the definition, members and nonmembers of the Association were invited to judge the merits and faults of the definition and to recommend areas needing further debate, analysis, or modification. The purpose of this article is to apply principles and rules of definition to an analysis of the working definition of nursing diagnosis as adopted by the NANDA General Assembly. In presenting this analysis, concerns and questions regarding the conceptual, logical, and grammatical clarity of essential elements (e.g., clinical judgment; individual, family, or community responses; actual or potential health problems; and actual or potential life processes) in the definition are posed; and, where appropriate, suggestions for clarification are offered. Further debate, research, and clinical testing is requested in an attempt to improve NANDA's very important contribution to the development of nursing practice theory.     

Invited Paper: Teaching Nursing Diagnosis to Increase Utilization After Graduation

BACKGROUND. The majority of nursing programs identify the nursing process and diagnosis as critical elements in their curricula, yet it is often absent in classroom and clinical discussions. The failure of faculty to integrate the nursing process and diagnoses into learning experiences creates students spending endless hours creating a care plan document that requires little critical thinking, a document that does not improve the student's likelihood of utilizing nursing diagnosis after graduation. PURPOSE. This paper would outline the educational barriers for integration of these concepts into practice. DISCUSSION. Classroom and clinical strategies that guide the student to focused learning on nursing diagnoses and utilize standardized predicted care plans can produce desired curriculum outcomes, and ultimately, practice utilization will be presented.     

The Development of NANDA's Nursing Diagnosis Taxonomy

In the early 1970s the need for a precise and computerizable language of nursing phenomena was identified. This need stimulated the formation of the National Conference Group for the Classification of Nursing Diagnoses The group began the work of identifying nursing diagnoses and developing a taxonomic structure for their classification. Based on the initial success with the development of nursing diagnoses, the conference group became the North American Nursing Diagnosis Association (NANDA). There are two benefits of taxonomic development within nursing: one is scientific in nature, while the other is applied or practical. The development of this taxonomy has occurred over a span of 17 years including nine national conferences. Details of this development have been abstracted from the proceedings of the nine conferences and the minutes of the Taxonomy Committee in order to explicate the taxonomic structure. The rules for the classification, developed by the committee, are presented. Future directions for taxonomic development and collaboration with other health care professions are proposed.     

口臭患者应用口臭仪与闻诊诊断的效果评价及护理

目的观察口臭仪与闻诊的临床应用效果,探讨口臭检测的最佳方法。方法将125例主诉口臭就医者,分别采用传统闻诊和口臭仪两种方法检测口臭,然后观察两者口臭检出率和操作方法的优劣。结果口臭检出率:口臭仪67.2%,闻诊71.2%,经2χ检验,2χ=1.18,P>0.05,无显著性差异;被检者对操作方法满意度调查:口臭仪95.2%,闻诊43.2%,经2χ检验,2χ=78.18,P<0.05,有显著性差异。结论口臭仪在口臭的检出率上稍有不足而在操作方法上却有较大的优势。认为将传统闻诊的方法改良为首选口臭仪检测口臭,部分阴性者(约4%)再通过闻诊确认,便可弥补两者的不足,是更行之有效的检测方法,值得临床应用和推广。