Supporting Breast‐feeding When a Woman Is Homeless

PURPOSE. This case study demonstrates use of standardized nursing languages in the care of new mothers in community settings. DATA SOURCES. The author collected data from clinical practice as an instructor in a baccalaureate nursing program and from the research literature. DATA SYNTHESIS. The appropriate nursing diagnoses, outcomes, and interventions were identified in partnership with the new mother. CONCLUSIONS. This case shows that NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) are useful to direct nursing care in community settings. IMPLICATIONS FOR NURSING. When teaching nursing students in a baccalaureate program, nurse faculty can use NANDA‐I, NOC, and NIC classifications to guide the growing practice of nursing students in community settings.     

Mapping Nursing Intervention Data Into the Nursing Interventions Classification (NIC): Process and Rules

TOPIC. Uniform language in nursing is needed to clearly depict the contributions of nursing in the healthcare arena but little data related to nursing interventions and patient outcomes are standardized.
PURPOSE. To investigate the feasibility of mapping nonstandardized nursing interventions into standardized language using the Nursing Interventions Classification (NIC).
SOURCE. Data from a Midwest community hospital's Computerized information system.
CONCLUSIONS. Results demonstrate that nonstandardized nursing orders can be mapped into standardized language using the NIC.     

Application of Orem''s Self-Care Deficit Theory and Standardized Nursing Languages in a Case Study of a Woman with Diabetes

PURPOSE: This paper aims to illustrate the process of theory-based nursing practice by presenting a case study of a clinical nurse specialist's assessment and care of a woman with type 2 diabetes. DESIGN: Orem's self-care deficit theory and standardized nursing language, NANDA, NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification), guided assessment and the identification of outcomes and interventions related to the client's management of diabetes. FINDINGS: Theory-based nursing care and standardized nursing language enhanced the client's ability to self-manage the chronic illness: diabetes. CONCLUSION: Nursing theory and standardized nursing language enhance communication among nurses and support a client's ability to self-manage a chronic illness.     

Nurse autonomy,nurse job satisfaction and client satisfaction with nursing care: their place in nursing data sets

Many changes have taken place in the healthcare system that have influenced nurse autonomy, job satisfaction and client satisfaction. Standardized language facilitates communication within the discipline of nursing. Examples of such language include the Nursing Intervention Classification (NIC) and the Nursing Outcomes Classification (NOC) systems as well as the Nursing Minimum Data Set (NMDS), which provides a formal structure for electronic data sets to support nursing care. The Nursing Management Minimum Data Set (NMMDS) was designed to identify variables to guide nurse managers in evaluating the impact of nursing interventions on client outcomes. Gaps within NMDS and NMMDS are discussed, and solutions are proposed.     

Utility of a Standardized Nursing Terminology to Evaluate Dosage and Tailoring of an HIV/AIDS Adherence Intervention

PURPOSE: To illustrate the utility of a standardized nursing terminology to calculate the dosage of the Client Adherence Profiling-Intervention Tailoring (CAP-IT) and to determine the extent to which a tailored intervention was delivered to 117 persons with HIV/AIDS who participated in the experimental arm of a randomized controlled trial (RCT). METHODS: The intervention nurse assigned nursing diagnoses from the Home Health Care Classification (HHCC) based upon CAP scores. During the IT phase of CAP-IT, the nurse delivered and documented a tailored set of nursing interventions associated with the CAP and assigned nursing diagnoses. Hierarchical linear regression was used to evaluate the extent to which the number of interventions and intervention times were tailored to client needs. RESULTS: Linear regression models that included CAP scores and nursing diagnoses as predictor variables explained 53.2% of the variance in total number of interventions and 58.9% of the variance in intervention time. CONCLUSIONS: The use of the standardized nursing terminology enabled calculation of the intervention dose and documentation that a tailored intervention was delivered.     

The study of nursing documentation complexities

This study aimed to explore complexities in nursing documentation and related factors. Nursing documentation has been one of the most important functions of nurses since the time of Florence Nightingale because it serves multiple and diverse purposes. Current health-care systems require that documentation ensures continuity of care, furnishes legal evidence of the process of care and supports evaluation of quality of patient care. However, nursing documentation has not served such objectives because of its complexities. This study explores nursing documentation complexities and related factors through both qualitative and quantitative methodologies. The study used multiple methods of inquiry: in-depth interviewing; participant observation; nominal group processing; focus group meetings; time and motion study of nursing activities; and auditing of completeness of nursing documentation. Complexities in nursing documentation include three aspects: disruption, incompleteness and inappropriate charting. Related factors that influenced documentation comprised: limited nurses' competence, motivation and confidence; ineffective nursing procedures; and inadequate nursing audit, supervision and staff development. These findings suggest that complexities in nursing documentation require extensive resolution and implicitly dictate strategies for nurse managers and nurses to take part in solving these complicated obstacles.     

Coining and Defining Novel Nursing Terminology. Part 2: Critical Incident Nursing Intervention

PURPOSE. In the second of a three‐part series, a novel nursing terminology is introduced and proposed for inclusion in the Nursing Interventions Classification (NIC): Critical incident nursing intervention (CINI), defined as any indirect or direct care registered nurse–initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a critical incident nursing diagnosis (CIND). A CIND is defined as recognition of an acute life‐threatening event that occurs as a result of disease, surgery, treatment, or medication. DATA SOURCES. The literature, research studies, meta‐analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. DATA SYNTHESIS. The current nursing interventions in the NIC 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. CONCLUSION. Coining and defining novel nursing terminology, CINI, for patient care during life‐threatening situations is important and fills the gap in the current standardized nursing terminology. IMPLICATIONS FOR NURSING PRACTICE. Refining the NIC will permit nursing researchers, among others, to conduct studies on nursing interventions in conjunction with the proposed novel nursing terminology, CINI. The first article in this series (Part 1) introduced the novel nursing terminology: CIND; the present article (Part 2) introduces the novel nursing terminology: CINI; and the third article in this series (Part 3) will introduce the novel nursing terminology: critical incident control.     

Application of Orem's Self‐Care Deficit Theory and Standardized Nursing Languages in a Case Study of a Woman with Diabetes

PURPOSE. This paper aims to illustrate the process of theory‐based nursing practice by presenting a case study of a clinical nurse specialist's assessment and care of a woman with type 2 diabetes. DESIGN. Orem's self‐care deficit theory and standardized nursing language, NANDA, NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification), guided assessment and the identification of outcomes and interventions related to the client's management of diabetes. FINDINGS. Theory‐based nursing care and standardized nursing language enhanced the client's ability to self‐manage the chronic illness: diabetes. CONCLUSION. Nursing theory and standardized nursing language enhance communication among nurses and support a client's ability to self‐manage a chronic illness.     

My First Patient as a Nurse Practitioner: A Man With Low Literacy

PURPOSE: The purpose of this case study is to demonstrate the use of the nursing process and the standardized nursing languages of NANDA‐I, the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a man with low literacy to self‐manage his medication regimen. DATA SOURCES: The data sources for this article are clinical nursing practice, research evidence related to helping people with low literacy, and the books that explain NANDA‐I, NOC, and NIC. DATA SYNTHESIS: This case study demonstrates nurses’ clinical decision making in providing care for a person with low health literacy. CONCLUSIONS: Low health literacy should be considered when nurses identify the nursing diagnosis of Ineffective Self‐Health Management. After trust is established, a screening tool should be used to evaluate the person's literacy level. Active partnership of the nurse and the person supports interventions to assist the person implement the medication regimen. IMPLICATIONS FOR NURSING: Inadequate evaluation of health literacy may result in mislabeling a person as “nonadherent” or “noncompliant” to a medication or treatment regimen. Low literacy is often an unrecognized barrier to effective self‐health management.     

Case study: a young male with auditory hallucinations in paranoid schizophrenia

PURPOSE. The purpose of this case study is to demonstrate use of the nursing process and the standardized nursing languages of NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a young male with paranoid schizophrenia to deal with auditory hallucinations. DATA SOURCES. Data were obtained from the experience and expertise of the author and published literature. DATA SYNTHESIS. This case study demonstrates nurses' clinical decision making in providing care for an adolescent with mental illness. CONCLUSION. This case study provides the pertinent nursing diagnosis, patient outcomes, and nursing interventions for a young male with auditory hallucinations in paranoid schizophrenia. IMPLICATIONS FOR NURSING. The use of NANDA‐I, NOC, and NIC can provide the necessary framework for enhancing and improving the management of care with patients who experience auditory hallucinations in paranoid schizophrenia.     

The impact of nursing surveillance on failure to rescue

Greater amounts of nursing surveillance is thought to decrease failure to rescue but studies to date have used nurse staffing levels as a proxy for nursing surveillance. The purpose of this nursing effectiveness study was to examine the unique treatment effect of nursing surveillance on failure to rescue. Data were abstracted from 9 electronic clinical data repositories including the nursing documentation system that used the Nursing Interventions Classification (NIC) to record nursing care. Nursing surveillance was quantified as "high use" when the subjects received it an average of 12 times per day or more. Propensity scores were used to match subjects who had received high-dose nursing surveillance with subjects who received low-dose nursing surveillance (average of less than 12 times a day). The results indicate that when nursing surveillance is performed an average of 12 times a day or greater, there is a significant (p = .0058) decrease in the odds of experiencing failure to rescue (odds ratio [OR] = 0.52) compared to when surveillance was delivered an average of less than 12 times a day. Additional unique variables included in this study are robust levels of nurse staffing based on hourly data, medical treatments, pharmaceutical treatments, and nursing treatments. The use of propensity scores helped determine the unique contribution of nursing surveillance on failure to rescue in this observational study.     

Improved Quality of Nursing Documentation: Results of a Nursing Diagnoses, Interventions, and Outcomes Implementation Study

PURPOSE: To evaluate the impact of the quality of nursing diagnoses, interventions, and outcomes in an acute care hospital following the implementation of an educational program. METHOD: In a pretest-posttest experimental design study, nurses from 12 wards of a Swiss hospital received an educational intervention--an introductory class and consecutive classes, using a case discussion method--to implement nursing diagnoses, interventions, and outcomes. Two sets of 36 randomly selected nursing records were evaluated before and after implementation. The quality of documented nursing diagnoses, interventions, and nursing-sensitive patient outcomes was assessed by 29 Likert-type items with a 0-4 scale instrument, called Quality of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO) and tested using t-tests. FINDINGS: Significant enhancements in the quality of documented nursing diagnoses, interventions, and outcomes were found following the implementation of a planned educational program. CONCLUSIONS: The implementation of NANDA, NIC, and NOC (NNN) nursing diagnoses, interventions, and outcomes led to higher quality of nursing diagnosis documentation, etiology-specific nursing interventions, and nursing-sensitive patient outcomes. IMPLICATIONS FOR NURSING PRACTICE: Educational measures support nurses to improve documentation of diagnoses, interventions, and outcomes. The Q-DIO is a useful audit tool.     

Mapping Nursing Interventions From a Hospital Information System to the Nursing Interventions Classification (NIC)

TOPIC. Using the Nursing Interventions Classifications (NIC) as a standard to classify interventions identified in a hospital intervention system.
SOURCES. Literature and the authors experience with standardized data systems for nursing.
PURPOSE. To describe the processes used and the issues that arose as interventions from a hospital nursing information system were mapped to interventions in the NIC.
CONCLUSIONS. The NIC provided a standard for the classification of nursing interventions from a hospital information system resulting in data that could be compared across sites. Ongoing testing of nursing intervention classifications is recommended.     

Case Study: Child With Global Developmental Delay

PURPOSE. This case study focused on the care of a child with global developmental delay. DATA SOURCES. Data were obtained through the author's clinical practice in long‐term care pediatric rehabilitation and literature sources. DATA SYNTHESIS. NANDA‐International Classifications, the Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) were used to identify the appropriate nursing diagnosis, nursing interventions, and patient outcomes. CONCLUSIONS. This case study provides the pertinent nursing diagnoses, interventions, and outcomes for a child with global developmental delay. The interdisciplinary team approach and family involvement is addressed. IMPLICATIONS FOR NURSING. Use of NANDA, NIC, and NOC outcomes constructs for enhancing the care of a child with global developmental delay.     

Toward collecting a standardized nursing data set across the continuum: case of adult care nurse practitioner setting

Viable strategies are needed to move toward collection of a standardized nursing data set across settings for eventual use in examining nursing effectiveness. One strategy is to introduce potential nurse adopters to subsets of valid setting-specific standardized terms and measures to support adoption and initial implementation. The present study was designed to identify the "most clinically useful" NANDA (North American Nursing Diagnoses Association) diagnoses, NOC (Nursing Outcomes Classifications) outcomes, and NIC (Nursing Intervention Classifications) interventions pertinent to the adult care nurse practitioner setting. Ultimately, clinicians must recognize, however, that they will need to use additional terms and measures outside the subsets to more fully describe the nursing care provided.     

Synthesis of Methods, Rules, and Issues of Standardizing Nursing Intervention Language Mapping

TOPIC. Nursing language mapping.
PURPOSE. To synthesize the methods, rules and issues described in two studies that mapped nonstandardized nursing orderslinterventions into the Nursing Interventions Classification (NIC).
SOURCES. The methods and results of studies conducted by Moorhead & Delaney and Coenen et al.
CONCLUSIONS. Results indicate that the NIC is an effective classification of mapping nursing orders/interventions to support across-site comparisons of nursing treatments. A set of decision rules to support mapping of interventions to the NIC is outlined.     

Consensus‐Validation Study Identifies Relevant Nursing Diagnoses,Nursing Interventions,and Health Outcomes for People with Traumatic Brain Injuries

A consensus‐validation study used action research methods to identify relevant nursing diagnoses, nursing interventions, and patient outcomes for a population of adults with traumatic brain injury (TBI) in long‐term care. In meetings totaling 159 hours to reach 100% consensus through group discussions, the three classifications of NANDA International's (NANDA‐I's) approved nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) were used as the basis for three nurses experienced in working with adults with TBI to select the elements of nursing care. Among almost 200 NANDA‐I nursing diagnoses, 29 were identified as relevant for comprehensive nursing care of this population. Each nursing diagnosis was associated with 3–11 of the more than 500 NIC interventions and 1–13 of more than 300 NOC outcomes. The nurses became aware of the complexity and the need for critical thinking. The findings were used to refine the facility's nursing standards of care, which were to be combined with the interdisciplinary plan of care and included in future electronic health records.