Quality of nursing diagnosis and patient satisfaction. A review of the literature

This article presents the current state of the art regarding the relationship between nursing diagnostics and patient satisfaction. Of the 98 studies examined, nineteen met the inclusion criteria and were investigated by content analysis. Answering the question of a possible relationship is based on a preceding conceptual analysis of nursing diagnostics and patient satisfaction. The results yield concept clarifications and rationales for these concepts. Nurses aiming to meet patients' needs and giving patient centred care use nursing diagnostics. Nursing diagnostics allow specific assessments of nursing problems and provide the basis for nursing interventions. Nursing diagnoses influence all elements of professional practice and are basic for patient classification systems. Patient satisfaction was mainly investigated in relation to the nursing process and often showed high overall scores. The interactive, social and supporting skills of nurses are most important for patient satisfaction. Nursing diagnostics and patient satisfaction have been evaluated frequently. However, only little research was done to find results about their relationship. The state of the current literature is discussed and recommendations for further research are presented. The literature review yields implications for practice and education.     

Helping a Man with Leprosy: A Case Study

PURPOSE.  This case study illustrates nursing diagnoses and interventions for a man with leprosy.
DATA SOURCES.  Data sources were published literature on the disease of leprosy, and the experience and expertise of the authors in working with people with leprosy.
DATA SYNTHESIS.  Data were synthesized using the standardized nursing languages of North American Nursing Diagnosis Association International and the Nursing Interventions Classification. The accuracy of the diagnoses and the appropriateness of the nursing interventions were supported by the positive health outcomes of the patient.
CONCLUSIONS.  Although leprosy has been eradicated in some countries, the risk of new cases is present anywhere that Mycobacterium leprae still exists. The recommended treatment of multibacilar polychemotherapy has lowered the rate of new cases in Brazil.
IMPLICATIONS FOR NURSING PRACTICE.  Nurses need to incorporate evidence-based practice interventions for leprosy-based wound care, and nurses should encourage persons with leprosy to maintain regular medical care with multibacilar polychemotherapy.     

The impact of nursing diagnoses in a long-term care setting

Nursing diagnosis as a critical component of the nursing process provides a common taxonomy to describe problems that nurses can treat and is a convenient, logical way to reference nursing standards. Theory is translated into practice with the use of population-specific prototype care guides and a written orders system. Nurses in leadership are responsible for providing the necessary resources to promote professional growth and facilitate desired change. Recommendations to assist with the implementation of nursing diagnosis are identified in Table 1. The system is dependent on staff nurses' professional commitment to learning and willingness to actively participate in change. Involvement of staff nurses continues to be a critical factor in the improvement of nursing practice.     

Minnesota Nurses' Perceptions of Nursing Diagnoses

PURPOSE. The study aims to identify Minnesota nurses' perceptions regarding nursing diagnoses and to examine how these perceptions have changed over time. METHODS. Five hundred sixty‐four out of 2,000 randomly selected registered nurses in Minnesota responded to the Perceptions of Nursing Diagnosis Survey. FINDINGS. Nurses have neutral to slightly negative perceptions of nursing diagnoses. These results differ slightly from the results of the original study which demonstrated neutral to slightly positive perceptions. IMPLICATIONS. After 30 years of use, it is concerning that more than half of nurses surveyed have a negative perception of nursing diagnosis. Consideration should be given to methods that facilitate the use of nursing diagnoses in practice, improvement of diagnostic language, or a more accepted method of planning patient care.     

Vigilance: the essence of nursing

Nursing, perhaps more than any other health care profession, claims caring as fundamental to its practice. Professional vigilance is the essence of caring in nursing. This article uses historical and theoretical bases to define professional vigilance and discuss its components. Two types of nursing diagnoses, central and surveillance, are proposed. Central diagnoses indicate the need for the nurse to plan and implement interventions for the achievement of outcomes. North American Nursing Diagnosis Association (NANDA)-approved diagnoses fall in this category. Surveillance diagnoses are those that recognize patient risks that are anticipated by the nurse, who remains ready to act in the event of occurrence. The profession, as a whole, and language developers, in particular, need to expand standardized nursing diagnosis terminology so that the contribution of nurses' vigilance to patient safety may be effectively communicated and documented.     

警惕性-护理的要素

护理及其它卫生保健职业在其实践过程中基本的要求是照护,专业的警惕性是护理中照护的要素。本文运用历史学和理论学为基础结合专业的警惕性,探讨它的构成要素。介绍了护理诊断的两种形式(中心和监视诊断)。中心诊断是指护士对指定计划完成和实施措施的评估,北美护理诊断学会批准了这种类型的诊断。监视诊断是护士评估预期的患者的风险,为突发事件做准备。整体而言,职业和术语研究者要扩大护理诊断术语使其标准化,以利于护士对患者安全的警惕性进行有效的沟通和实践。     

Chemical impairment in colleagues: perceptions of Western New York nurses.

The purpose of this study was to determine nurses' perceptions about substance abuse in professional colleagues, opinions about strategies for dealing with substance abuse, and knowledge about resources available for dealing with the problem of chemical impairment. Subjects included a convenience sample of 161 nurses from Western New York. Data were gathered by a questionnaire that included "The Perceptions of Nursing Impairment Inventory" and items regarding respondents' background characteristics, suspicions about alcohol and drug abuse in nurse colleagues, and knowledge about and use of peer assistance services available through District I of the New York State Nurses Association. The major outcome of the study was identification of a knowledge deficit on the extent of the substance abuse problem in nursing, ability to recognize an impaired colleague, and awareness of services available. These data substantiate the need for implementing educational programs to increase nurses' basic knowledge of, and sensitivity to, the problem of chemical dependency.     

Parish nurse practice with client aggregates

The purpose of this study was to describe 1 aspect of parish nurses' practice: working with client aggregates. Nineteen parish nurses practicing in 22 faith communities collected data using 2 standardized nursing classification systems--North American Nurses Diagnosis Association Taxonomy and Nursing Intervention Classification. Nurses recorded 77 group encounters for services provided over a 5-month period. The most frequent nursing diagnoses and nursing interventions are reported and emphasize health promotion and illness prevention. The parish nurse roles of educator, counselor, referral agent, and advocate-facilitator described in the literature were consistent with the findings of this study. In addition, the parish nurse as a member of the ministerial team is discussed. A focus group of the parish nurses provided validation of the results of aggregate practice.     

Implementing nursing diagnostics effectively: cluster randomized trial

Title. Implementing nursing diagnostics effectively: cluster randomized trial. Aim. This paper is a report of a study to investigate the effect of guided clinical reasoning. This method was chosen as a follow‐up educational measure (refresher) after initial implementation of standardized language. Background. Research has demonstrated nurses’ need for education in diagnostic reasoning to state and document accurate nursing diagnoses, and to choose effective nursing interventions to attain favourable patient outcomes. Methods. In a cluster randomized controlled experimental study, nurses from three wards received guided clinical reasoning, an interactive learning method. Three wards, receiving classic case discussions, functioned as control group. Data were collected in 2004–2005. The quality of 225 randomly selected nursing records, containing 444 documented nursing diagnoses, corresponding interventions and outcomes was evaluated by applying 18 Likert‐type items with a 0–4 scale of the instrument Quality of Nursing Diagnoses, Interventions and Outcomes. The effect of guided clinical reasoning was tested against classic case discussions using T‐tests and mixed effects model analyses. Findings. The mean scores for nursing diagnoses, interventions and outcomes increased significantly in the intervention group. Guided clinical reasoning led to higher quality of nursing diagnosis documentation; to aetiology‐specific interventions and to enhanced nursing‐sensitive patient outcomes. In the control group, the quality was unchanged. Conclusion. Guided clinical reasoning supported nurses’ abilities to state accurate nursing diagnoses, to select effective nursing interventions and to reach and document favourable patient outcomes. The results support the use of the North American Nursing Diagnosis Association, Nursing Interventions Classification and Nursing Outcomes Classification classifications and demonstrate implications for the electronic nursing documentation.     

Nursing Diagnoses and Interventions of Japanese Patients with End-Stage Breast Cancer Admitted for Different Care Purposes

PURPOSE: To clarify actual nursing diagnoses for and interventions given to patients with end-stage breast cancer admitted for different care purposes. METHODS: Nursing diagnoses, defining characteristics, related/risk factors, and nursing interventions were analyzed in a convenience sample of 150 patient records. FINDINGS: A total of 539 nursing diagnoses (96 labels) were documented. Frequently listed diagnoses were chronic pain, risk for infection, and activity intolerance. The most frequently used nursing diagnosis for the chemotherapy group was risk for infection. The nurses in this study rarely report any diagnoses related to death and dying. CONCLUSIONS: Nursing diagnoses and interventions differed depending on the purpose of admission. PRACTICE IMPLICATIONS: Oncology nurses need to consider the reasons for admission when making nursing diagnoses and interventions for patients with end-stage breast cancer.     

A Conceptual Framework for Nursing Diagnoses: Alterations in Urinary Elimination

Ever since nurses began examining and encouraging the use of nursing diagnosis, it has been a challenge to develop feasible labels. Progress, though, is being made. Developing nursing diagnoses that all nurses can use is the first step in identifying effective and appropriate interventions. This author has perceived the need to examine more closely the problem of urinary incontinence. A literature search combined with clinical observation and review of anatomy and physiology helped to identify five specific nursing diagnoses. They are: urinary retention, stress incontinence, urge incontinence, reflex incontinence, and uncontrolled incontinence. The following is intended to show the development of these nursing diagnoses and to examine what characteristics were helpful in their development. At the first conference on nursing diagnoses, diagnostic labels were derived through brainstorming among nurses ( Fehring, 1983 ). This was a starting place. At the sixth conference, Gordon (1984) expressed the need for refinement of nursing nomenclature and taxonomy to allow for a more cognitively manageable system of nursing diagnoses. She suggested that this refinement, in part, consist of brevity in labels and identification of a few critical defining characteristics for each diagnosis ( Gordon, 1984 ). At the fifth North American Nursing Diagnosis Association (NANDA) conference, a taxonomy was developed using all existing, accepted nursing diagnoses. It was discovered that labels are on several levels of abstraction. Many think that frustration in making diagnoses is in part related to use of labels that are too abstract. The committee that developed the taxonomic tree indicated areas where movement toward more concrete levels of diagnosis might occur. This article describes the movement of a relatively abstract nursing diagnosis “Alterations in Urinary Elimination” to the formation of five more concrete diagnoses.     

Validation of defining characteristics: retrospective design

The American Association of Neuroscience Nurses (AANN) has accepted the concept of nursing diagnosis as one component of a general nursing framework which is designed to direct and evaluate the care of individuals with neuroscience dysfunction. Continuing development of nursing diagnosis as a conceptual basis for neuroscience practice is dependent upon several factors, one of which is research-based identification and validation of defining characteristics associated with nursing diagnoses commonly used in the care of patients with neurologic dysfunction. Defining characteristics are observable signs and symptoms present in the person with the problem. Identification and validation of defining characteristics are essential to the continued development and use of nursing diagnosis in nursing practice. Without clear, specific defining characteristics, neuroscience nurses are unable to effectively assess patients for the signs and symptoms necessary to formulate nursing diagnoses, monitor patient status or evaluate nursing interventions. One way to validate defining characteristics is the use of retrospective design.     

A TIME for nursing portfolios. A tool for career development.

Nursing portfolios are purposeful collections of a nurse's tangible and intangible skills, including critical thinking, communication, and clinical abilities. They can be used for any number of creative career and professional development paths. Nurses should select portfolio pieces representative of their personal philosophy of nursing and display the professional image they choose to create. Through self-reflection, neonatal nurses may showcase talents they feel make their practice distinctive. This article describes the purpose, importance, process, and uses of professional nursing portfolio development. Through the process of self-reflective practice and clinical experience, nurses are empowered to continue on the path of career development and professionalism.     

Ethical dilemmas in perioperative nursing practice

Ethical dilemmas in perioperative nursing practice occur during all phases and in every practice setting. Awareness of commonly experienced dilemmas and understanding of a model available to analyze and resolve these dilemmas can benefit patients and perioperative nurses. Patients will benefit from nurse advocates who recognize and act to resolve actual and potential ethical dilemmas. Nurses will benefit when they are empowered with the knowledge and ethical skills to enhance patient autonomy, to protect dignity and confidentiality, and human rights. Perioperative nurses should reflect on previous dilemmas and use them to assist with resolution of similar dilemmas. They should be knowledgeable of personal, departmental, institutional, and professional resources available when faced with ethical dilemmas. The ANA code for Nurses and the AORN Statements of Competency in Perioperative Nursing are two resources available to perioperative nurses. In the increasingly complex, technologically laden surgical environment, patients who are sicker and living longer will require services of highly skilled and educated professionals. They are vulnerable in the surgical setting and need surgical teams to act on their behalf. Perioperative nurses with ethical skill are an asset to patients and other members of the surgical team when they seek to resolve ethical dilemmas in knowledgeable and systematic ways.     

The importance of research to school nurses and school nursing practice.

Historically, school nursing has not documented sufficiently the health issues in schools, nor has it prioritized these issues for school nursing interventions or evaluated the effectiveness of nursing interventions. The National Association of School Nurses (NASN) is strongly committed to the advancement of children's health. Thus, NASN is developing an infrastructure to support research that articulates the health conditions affecting children's school success and the contributions of school nursing to children's health and academic success. In 1999, NASN participated with the National Center for School Health and the National Nursing Coalition for School Health at a Research Summit to set a school nursing research agenda. Needs and issues were identified for future research activities. The primary outcome was the identification that school nurses must practice the standards of care pertaining to research. These standards specify that clinicians be informed about, supportive of, and participate in the conduct and use of research.     

Implementing nursing grand rounds in a community hospital

PURPOSE: The purpose of this article is to describe the process of implementing Nursing Grand Rounds in a community hospital. METHODS: The Advanced Practice Council of clinical nurse specialists and nurse practitioners used Benner's theoretical framework of skill acquisition to guide the process. The development and implementation included the following: (1) conducting a convenient interest survey, (2) establishing targeted marketing strategies and a delivery format template for Nursing Grand Rounds, (3) mentoring clinical nurses, and (4) evaluation. CONCLUSION: Our institution has established Nursing Grand Rounds as a forum "For our Nurses, By our Nurses." The forum was held quarterly with survey feedback demonstrating increased awareness by clinical nurses and growing attendance. IMPLICATIONS: As a designate Magnet hospital, our Advanced Practice Council established a forum to promote and demonstrate excellence in nursing. The attributes of advanced practice nursing are the cornerstone to successful implementation of Nursing Grand Rounds. The involvement of clinical nurses across the 5 stages of proficiency in skill acquisition is a means to retain clinical experts and foster the development of nurses from novice to expert.     

NANDA diagnoses, NIC interventions, and NOC outcomes used in an electronic health record with elementary school children.

This is a report of a secondary analysis of data from a published quasi-experimental feasibility study of the effects of implementing diagnoses from North American Nursing Diagnosis Association International, interventions from the Nursing Interventions Classification, and outcomes from the Nursing Outcomes Classification (referred to as NNN) on nurses' power and children's health outcomes. For this study, the NNN terms that were frequently used by nurses in the original study were identified through the nurses' printed reports of health-related visits (N = 766) with 103 New York City children in the 4th and 5th grades in six schools. The findings indicate that a large majority of nurses' efforts were focused on health promotion and management of risk states. Health problems such as pain and ineffective airway clearance were identified and were treated when present. Findings from this study can be combined with findings from previous studies to identify the diagnoses, interventions, and outcomes that are relevant for school settings. Use of the relevant NNN terms will provide data to support evidenced-based school nursing practice, education of school nurses, development of policies, and communication of the value of school nursing practice to stakeholders.