Postdischarge nursing interventions for stroke survivors and their families

BACKGROUND: The physical, cognitive, and emotional sequelae of stroke underscore the need for nursing interventions across the continuum of care. Although there are several published studies evaluating community interventions for stroke survivors, the nursing role has not been clearly articulated. AIM: The aim of this paper is to report a study to describe, using a standardized classification system, the nursing interventions used with stroke survivors during the initial 6 weeks following discharge home. METHODS: In the context of a randomized controlled trial, two nurse case managers provided care to 90 community-dwelling stroke survivors who were assigned to the intervention arm of the trial. The nursing documentation was analysed, using the Nursing Intervention Classification (NIC) system, to identify and quantify the interventions that were provided. FINDINGS: Stroke survivors received, on average, six different interventions. There was a trend for those who were older, more impaired, and who lived alone to receive more interventions. The most commonly reported interventions included those directed towards ensuring continuity of care between acute and community care, family care, and modifying stroke risk factors. The study was limited to the nursing documentation, which may represent an underestimation of the care delivered. CONCLUSIONS: The NIC system was useful in capturing the interventions delivered by the nurse case managers. Nursing interventions are often not clearly articulated and less often use standardized terminology. Describing nursing activities in a standard manner will contribute to an increase in nursing knowledge and to evidence-based practice.     

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.     

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.     

Case Study: A Woman Who Hemorrhages 24 Hours Post Tonsillectomy

PURPOSE. This case study focused on the emergency nursing care of a 32‐year‐old female, less than 24 hours post operatively from a tonsillectomy. The purpose is to identify the priority nursing diagnoses, patient outcomes, and nursing interventions that guided nursing care during this emergency. DATA SOURCES. Data were obtained through the author's clinical practice in emergency nursing and literature sources. DATA SYNTHESIS. NANDA International Classification, the Nursing Outcomes Classification, and the Nursing Interventions Classification were used to identify the appropriate nursing diagnosis, patient outcomes, and nursing interventions of an adult with a postoperative hemorrhage. CONCLUSIONS. This case study provides emergency nurses and students with the pertinent nursing diagnoses, patient outcomes, and nursing interventions for persons with post‐op hemorrhage after tonsillectomy.     

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.     

Nursing Diagnoses of Burned Patients and Relatives' Perceptions of Patients' Needs

PURPOSE.  The aims of this study were to identify the nursing diagnoses of burn patients in the period 1 week before hospital discharge and to determine whether their relatives had similar perceptions of the patients' problems.
METHODS.  A qualitative case study was conducted with 10 burn patients and 10 family members. One week before hospital discharge, the nursing diagnoses of the patients and the relatives' perceptions of the patients' were identified and compared.
FINDINGS.  Thirty different diagnoses related to physical and psychosocial aspects were identified. The family members reported concerns mainly related to physical care, specifically wound care and prevention of infection, and psychosocial aspects, while patients were primarily concerned with the latter.
CONCLUSIONS.  Nursing diagnoses for these patients and their relatives' perceptions frequently overlapped; however, the emphasis of the families' attention was on the physical aspects.
IMPLICATIONS FOR NURSING PRACTICE.  Anticipating family members' perceptions about the patients' problems is important in order to promote strategies that will improve patient care after hospital discharge.     

Development of parent–nurse relationships in neonatal intensive care units – from closeness to detachment

Title. Development of parent–nurse relationships in neonatal intensive care units – from closeness to detachment Aim. This paper is a report of a study to explore the development of relationships between parents and nurses in a neonatal intensive care unit. Background. As increasingly smaller premature babies survive, the prolonged hospitalization that follows makes relationships between parents and nurses crucial. A collaborative partnership in which all the family members’ needs are acknowledged is suggested as the best approach. Method. A hermeneutic approach was adopted, using overt participant observation (160 hours) and in‐depth interviews to study interactions between parents and nurses. The participants were six mothers, six fathers, and six nurses from a 13‐bed Norwegian neonatal intensive care unit. Data were obtained over 27 weeks from 2003 until 2004. Findings. A partnership between parents and nurses developed in three phases: the acute critical phase, the stabilizing phase, and the discharge phase. The stabilizing phase seemed the most challenging. As exhausted parents expressed the importance of maintaining the trusting relationship with their primary nurses to become confident when assuming more responsibility and adjusting to the new situation, nurses purposely withdrew and reduced their contact with parents, facilitating their independence and confidence as caretakers. Parents and nurses rarely seemed to discuss with each other the discrepancy in their understanding of the detachment process. Conclusion. Acknowledging the need for parents and nurses to discuss the processes of involvement and detachment may contribute positively to the development of family‐centred care in neonatal intensive care units.     

Nursing care plan for the informal caregiver. A case report

We define the caregiver as the person responsible for attending the daily needs of another person who is unable to care for him/herself due to illness or disability. Caregivers are responsible for the physical, emotional and often financial support of these individuals. Family caregivers are described as "informal" by health professionals to refer to those who care for members of their own family without payment. We describe the case of a mother (informal caregiver) with a 24-year-old son who was totally dependent. An individual nursing care plan was developed, in which risk for caregiver role strain related to the severity and chronicity of the care receiver's condition, among other diagnoses, was detected. This plan includes desired outcomes and nursing interventions. Primary care nurses should pay special attention to the care of these informal caregivers.     

The impact of family-centered care interventions on neonatal and parental outcomes in a Turkish hospital

AimThis study aimed to improve nurses’ attitudes towards parental engagement and to examine the impact of implementing nursing interventions related to family-centred care on neonatal and parental outcomes in a university hospital in Turkey.MethodsA quasi-experimental, nonequivalent, and post-test research design was used. Using convenience sampling, the study was completed with 128 preterm infants and their parents, including 64 in the experimental group and 64 in the control group at a neonatal intensive care unit of a university hospital. The control group data were collected from medical records and parents before practising family-centred nursing interventions developed for the experimental group. In addition, nurses were given a four hour training session aimed to improve their attitudes towards parental participation in care, with the nurses’ attitudes measured before, immediately after, and one month after the training. The experimental group data were collected from medical records and parents after 10 nursing interventions based on family-centred care supported by managers began to be implemented by trained nurses in the neonatal intensive care unit. The Parent-Preterm Infant Characteristics Form, Maternal Attachment Inventory, Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N), and Parental Engagement Attitude Scale were used for the data collection.FindingsWhile nurses’ scores of attitudes toward parental participation obtained immediately after and one month after the training were higher than those before the training, the scores one month after were lower compared to those immediately after. The results indicated that discharge weight gain of infants in the experimental group were significantly higher than those in the control group and that there was no significant difference between the groups in length of stay at neonatal intensive care unit. The maternal attachment and satisfaction scores of the parents in the experimental group were significantly higher than those in the control group.ConclusionImplementing family-centred nursing care interventions, developed based on unit needs and supported by managers, with trained neonatal intensive care nurses positively impacted parent-infant attachment, parent satisfaction, and infant weight gain.     

家庭参与式护理在新生儿病房优质护理服务中的应用

目的探讨家庭参与式护理在新生儿病房优质护理服务中的应用效果。方法 2015年5月至2016年5月,采用便利抽样法选择在湖南省儿童医院新生儿病房住院的130例新生儿为研究对象,按随机数字表法将其分为观察组和对照组各65例,观察组住院后期在护士的指导下家长参与新生儿的喂养、保暖、沐浴、脐部护理、臀部护理等部分护理工作。对照组住院期间所有的护理工作均由护士完成。比较两组新生儿家长在新生儿出院时对新生儿基本护理知识和护理技能的掌握情况,并比较两组新生儿出院后1个月体质量、身长、头围增长情况、家属满意度及再入院率。结果观察组新生儿家长对新生儿基本护理知识和护理技能的掌握情况及新生儿出院后1个月体质量、身高、头围的增长及家属满意度均明显高于对照组(均P0.05),而新生儿出院后1个月再入院率则明显低于对照组(P0.05)。结论在护士指导下家庭参与新生儿住院期间部分护理工作,能够满足新生儿及其家属的需要,促进新生儿健康成长,减少再入院率,提高新生儿病房家属满意度。     

基于同一中心257例青少年特发性脊柱侧弯术后病人父母的家庭护理认知调查及常见问题分析

[目的]调查青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)术后病人父母的家庭护理认知情况及常见问题。[方法]对257例接受手术治疗AIS病人的父母进行问卷调查,了解其对AIS病人术后家庭护理知识的认知情况以及护理过程中常见问题,并分析其发生的影响因素。[结果]95例病人父母在出院前家庭护理知识未达标,这些病人多为非独生子女、居住于农村、家庭收入及父母受教育程度均较低(P均<0.05)。257例病人父母家庭护理认知平均分为(23.8±5.6)分,其中在功能锻炼方面得分较低。术后家庭护理知识未达标组病人父母在功能锻炼、生活护理及切口护理评分上均低于达标组(P均<0.05)。AIS病人父母在术后家庭护理过程中常见的问题为术后相关问题。相比于达标组,未达标组病人父母在失眠、担心照顾病人方式不当、病人恢复不佳以及病人无法独自处理问题方面的发生率较高,差异具有统计学意义(P均<0.05)。[结论]术后病人父母的家庭护理认知受多方面因素影响,护理知识宣教在提高病人父母家庭护理认知程度中起重要作用,应加强术后功能锻炼方面的知识宣教。     

The Relationships Among Nursing Diagnoses in Discharge Planning for Patients With Lung Cancer

An explanatory study was designed to investigate whether nursing diagnoses present at discharge from the hospital accurately describe the complexity of care required in the community. A sample of 196 patients with lung cancer referred to community agencies at discharge was described by types of nursing diagnoses; types of agencies needed and services required; and by age, gender, race, economic status, and hospital length of stay. Using multiple logistic regression, a model for home care referral resulted in four significant predictor diagnoses : altered nutrition: less than body requirements, bathing/hygiene self-care deficit, high risk for infection, and high risk for injury. The model for hospice referral resulted in four significant predictor diagnoses : anticipatory grieving, impaired skin integrity, high risk for impaired skin integrity, and pain. The data suggest that the nursing diagnoses described the discharge planning needs, which predicted the type of agency referral needed.     

Nurses’ views and practices on parental mental illness: An integrative review

When a parent has a mental health problem, family members can be affected by it. Nursing professionals can provide care for the whole family, including children. Nurses can support the parental role of parents with mental illness. This integrative review aimed at the following: To identify and to synthesize the views and practices of nurses on parental mental illness (PMI). An integrative review methodology was employed, following PRISMA guidelines. Theoretical and empirical literature was included. Twenty-three articles were obtained to be analysed, using the Whittemore and Knafl approach. A lack of knowledge about nurses' views and practices on PMI was found. Especially, in some demographic areas such as Mediterranean countries and Central and South America. Different issues which influence how nurses perceive PMI were identified: subjective meaning of family concept, personal experience of being parent, and perceptions of mental illness, among others. The main findings on nurses’ practices were as follows: guidelines to implement family-focused practices, knowledge, and skills; therapeutic relationship; and teamwork and interagency communication; among others. These issues are intimately related. They could act as enablers or barriers to support parental role of parents with mental illness. Adequate guidelines and policies are necessary to support parents with mental illness and their families. There is a need to include knowledge about PMI and family-focused approach in nursing education curricula. Training could include reflection on nurses’ experiences and personal values to become aware of how these can affect their interventions and practices.     

Nursing intervention studies on patients and family members: a systematic literature review

The development of evidence-based practice is a major current challenge in the fields of nursing practice and nursing research. A concerted effort is needed to develop and test interventions and to assess their impacts. The illness of one family member inevitably affects other family members and the whole family. Nursing interventions should be so designed that they support and enhance the life situation of both patients and their families. The aim of this study is to undertake a systematic review of nursing intervention studies on patients and family members published in international databases in 2001–2006. The main focus was on the targets, methods and impacts of interventions. The articles for the review were searched from Medline and Cinahl (n = 31) and analysed by content analysis and the RE-AIM evaluation model. The results showed that the interventions were targeted at patients with chronic diseases and individual family members. In addition to support components, the interventions included elements of teaching, counselling and education. The preliminary evidence indicated that the interventions were effective in relieving the burden of care and depressive symptoms of family members of Alzheimer, cancer, stroke and schizophrenia patients as well as in promoting their quality of life and coping. Nursing interventions are still in the development and testing phase. The challenge for the future is to broaden the scope and application of interventions in different nursing environments. Assessments of the efficacy of interventions should also consider their adaptation, implementation and maintenance in practical nursing.     

High Frequency: Treatment Priority Nursing Diagnoses in Critical Care

The purpose of this study was to identify high frequency-treatment priority nursing diagnoses in critical care nursing using survey research methods. Through a mailed survey the prevalence of 135 nursing diagnoses from the NANDA Diagnostic Taxonomy and other diagnoses was rated by a national, random sample of 678 critical care nurses. Six important diagnostic areas were: sleep-rest, activity, nutritional-metabolic, cognitive-perceptual, self-perception (mood state), and health management (risk) patterns. Twenty diagnoses were rated as nearly always or frequently present in their practice by 70% or more of the nurses. Findings can be used to focus clinical studies of the highly prevalent diagnoses.