Software development to support decision making in the selection of nursing diagnoses and interventions for children and adolescents

Objective:

to report the development of a software to support decision-making for the selection of nursing diagnoses and interventions for children and adolescents, based on the nomenclature of nursing diagnoses, outcomes and interventions of a university hospital in Paraiba.

Method:

a methodological applied study based on software engineering, as proposed by Pressman, developed in three cycles, namely: flow chart construction, development of the navigation interface, and construction of functional expressions and programming development.

Result:

the software consists of administrative and nursing process screens. The assessment is automatically selected according to age group, the nursing diagnoses are suggested by the system after information is inserted, and can be indicated by the nurse. The interventions for the chosen diagnosis are selected by structuring the care plan.

Conclusion:

the development of this tool used to document the nursing actions will contribute to decision-making and quality of care.     

Total staff costs to implement a decision support system in nursing

Objective

to identify the direct labor (DL) costs to put in practice a decision support system (DSS) in nursing at the University Hospital of the University of São Paulo (HU-USP).

Method

the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes.

Results

the DL cost corresponded to R$ 752,618.56 (100%), R$ 26,000.00 (3.45%) of which were funded by a funding agency, while R$ 726,618.56 (96,55%) came from Hospital and University resources.

Conclusion

considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing.     

Health disorders related to learning the welding trade: assessment of approaches to risk communication

Objective

to assess the identification of health disorders as self-reported by apprentices of welding and to analyze the strength of the relationship between age and time of experience with self-reported health disorders before and after a socio-environmental nursing intervention.

Method

this quasi-experimental, non-randomized, before-and-after study was conducted with 86 welding apprentices from a private entity.

Results

the results show a significant difference for the pre- and post-test means and an increase in the post-test mean score for the cardiovascular, respiratory and cutaneous systems. There was also a negative correlation between the apprentices'' ages and the identification of health disorders.

Conclusion

the socio-environmental nursing intervention enabled obtaining information on health disorders related to welding. In turn, such information enabled the apprentices to assess information and self-report health disorders.     

Implementation of the nursing process in a health area: models and assessment structures used

OBJECTIVE:

to analyze what nursing models and nursing assessment structures have been used in the implementation of the nursing process at the public and private centers in the health area Gipuzkoa (Basque Country).

METHOD:

a retrospective study was undertaken, based on the analysis of the nursing records used at the 158 centers studied.

RESULTS:

the Henderson model, Carpenito''s bifocal structure, Gordon''s assessment structure and the Resident Assessment Instrument Nursing Home 2.0 have been used as nursing models and assessment structures to implement the nursing process. At some centers, the selected model or assessment structure has varied over time.

CONCLUSION:

Henderson''s model has been the most used to implement the nursing process. Furthermore, the trend is observed to complement or replace Henderson''s model by nursing assessment structures.     

Quality of life of coronary artery disease patients after the implementation of planning strategies for medication adherence

OBJECTIVE:

to compare the general and specific health-related quality of life (HRQoL) between the Intervention (IG) and Control (CG) groups of coronary artery disease patients after the implementation of Action Planning and Coping Planning strategies for medication adherence and to verify the relationship between adherence and HRQoL.

METHOD:

this was a controlled and randomized study.

RESULTS:

the sample (n=115) was randomized into two groups, IG (n=59) and CG (n=56). Measures of medication adherence and general and specific HRQoL were obtained in the baseline and after two months of monitoring.

CONCLUSION:

the findings showed that the combination of intervention strategies - Action Planning and Coping Planning for medication adherence did not affect the HRQoL of coronary artery disease patients in outpatient monitoring.     

Development and validation of an educational booklet for healthy eating during pregnancy

OBJECTIVE:

to describe the validation process of an educational booklet for healthy eating in pregnancy using local and regional food.

METHODS:

methodological study, developed in three steps: construction of the educational booklet, validation of the educational material by judges, and by pregnant women. The validation process was conducted by 22 judges and 20 pregnant women, by convenience selection. We considered a p-value<0.85 to validate the booklet compliance and relevance, according to the six items of the instrument. As for content validation, the item-level Content Validity Index (I-CVI) was considered when a minimum score of at least 0.80 was obtained.

RESULTS:

five items were considered relevant by the judges. The mean I-CVI was 0.91. The pregnant women evaluated positively the booklet. The suggestions were accepted and included in the final version of the material.

CONCLUSION:

the booklet was validated in terms of content and relevance, and should be used by nurses for advice on healthy eating during pregnancy.     

Nurses' workload and its relation with physiological stress reactions

OBJECTIVE:

to analyze the relation between the workload and the physiological stress reactions among nurses working at a hospital service.

METHODS:

cross-sectional, correlational, quantitative study, involving 95 nurses, in 2011 and 2012. Spearman''s bivariate Correlation Test was used.

RESULTS:

most subjects are female, between 23 and 61 years old and working between 21 and 78 hours per week. The most frequent physiological reactions were back pain, fatigue/exhaustion, stiff neck and stomach acidity, with 46.3% of the subjects presenting low and 42.1% moderate physiological stress responses. No correlation was found between the workload and the physiological stress responses.

CONCLUSION:

although most of the nurses work more than 36 hours/week, physiologically, they do not present high reaction levels in response to stress. These workers deal with conflicts in the vertical and horizontal relations between professionals, family members and patients. In that sense, taking care of professionals who offer health services can be a fundamental strategy, as good user care mainly depends on healthy teams.     

Development and Implementation of a Clinical and Business Intelligence System for the Florida Health Data Warehouse

Objective

To develop and implement a Clinical and Business Intelligence (CBI) system for the Florida Health Data Warehouse (FHDW) in order to bridge the gap between Florida’s healthcare stakeholders and the health data archived in FHWD.

Materials and Methods

A gap analysis study has been conducted to evaluate the technological divide between the relevant users and FHWD health data, which is maintained by the Broward Regional Health Planning Council (BRHPC). The study revealed a gap between the health care data and the decision makers that utilize the FHDW data. To bridge the gap, a CBI system was proposed, developed and implemented by BRHPC as a viable solution to address this issue, using the System Development Life Cycle methodology.

Results

The CBI system was successfully implemented and yielded a number of positive outcomes. In addition to significantly shortening the time required to analyze the health data for decision-making processes, the solution also provided end-users with the ability to automatically track public health parameters.

Discussion

A large amount of data is collected and stored by various health care organizations at the local, state, and national levels. If utilized properly, such data can go a long way in optimizing health care services. CBI systems provide health care organizations with valuable insights for improving patient care, tracking trends for medical research, and for controlling costs.

Conclusion

The CBI system has been found quite effective in bridging the gap between Florida’s healthcare stake holders and FHDW health data. Consequently, the solution has improved in the planning and coordination of health care services for the state of Florida.     

The adaptation problems of patients undergoing hemodialysis: socio-economic and clinical aspects

OBJECTIVES:

to identify adaptation problems under Roy''s Model in patients undergoing hemodialysis and to correlate them with the socioeconomic and clinical aspects.

METHOD:

a transversal study, undertaken using a questionnaire. The sample was made up of 178 individuals. The Chi-squared and Mann-Whitney U tests were undertaken.

RESULTS:

the adaptation problems and the socioeconomic and clinical aspects which presented statistical associations were: Hyperkalemia and age; Edema and income; Impairment of a primary sense: touch and income; Role failure and age; Sexual dysfunction and marital status and sex; Impairment of a primary sense: vision and years of education; Intolerance to activity and years of education; Chronic pain and sex and years of education; Impaired skin integrity and age: Hypocalcemia and access; Potential for injury and age and years of education; Nutrition below the organism''s requirements and age; Impairment of a primary sense: hearing and sex and kinetic evaluation of urea; Mobility in gait and/or coordination restricted, and months of hemodialysis; and, Loss of ability for self-care, and months of hemodialysis and months of illness.

CONCLUSION:

adaptation problems in the clientele undergoing hemodialysis can be influenced by socioeconomic/clinical data. These findings contribute to the development of the profession, fostering the nurse''s reflection regarding the care.     

Systematization of Nursing Care in undergraduate training: the perspective of Complex Thinking

AIM:

to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility

METHOD:

longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed.

RESULTS:

The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035).

CONCLUSION:

the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.     

Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke

Objective:

to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration.

Method:

cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration.

Results:

risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration.

Conclusion:

dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration.     

Quality of life assessment of patients with and without venous ulcer

OBJECTIVES:

to compare the quality of life of patients with chronic venous disease with and without ulcer and to identify the most affected aspects.

METHOD:

cross-sectional study with a sample of 204 patients with chronic venous disease. The quality of life was assessed with the help of the SF-36 questionnaire. To compare the scores between the groups, the Mann-Whitney test was used, considering a statistically significant difference when p<0.05.

RESULTS:

the quality of life score of patients with ulcer was lower when compared to that of patients without ulcer, in all domains and dimensions of the SF-36, particularly in the domains physical aspect and functional capacity, with very low scores.

CONCLUSION:

all aspects of quality of life were more compromised in people with ulcers. These findings can contribute towards a better understanding of the effects of chronic venous disease on the quality of life and towards a better orientation of therapeutic interventions in this population.     

Theoretical assumptions of Maffesoli's sensitivity and Problem-Based Learning in Nursing Education

Objective

understand the everyday and the imaginary of Nursing students in their knowledge socialization process through the Problem-Based Learning (PBL) strategy.

Method

Action Research, involving 86 students from the second year of an undergraduate Nursing program in Spain. A Critical Incident Questionnaire and Group interview were used. Thematic/categorical analysis, triangulation of researchers, subjects and techniques.

Results

the students signal the need to have a view from within, reinforcing the criticism against the schematic dualism; PBL allows one to learn how to be with the other, with his mechanical and organic solidarity; the feeling together, with its emphasis on learning to work in group and wanting to be close to the person taking care.

Conclusions

The great contradictions the protagonists of the process, that is, the students experience seem to express that group learning is not a form of gaining knowledge, as it makes them lose time to study. The daily, the execution time and the imaginary of how learning should be do not seem to have an intersection point in the use of Problem-Based Learning. The importance of focusing on the daily and the imaginary should be reinforced when we consider nursing education.