Coining and Defining Novel Nursing Terminology. Part 3: Critical Incident Control

PURPOSE.  In the third of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the Nursing Outcomes Classification (NOC)—Critical incident control (CIC)—defined as a response that attempts to reverse a life-threatening condition. Critical incident nursing diagnosis (CIND), defined as recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication, and critical incident nursing intervention, 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 CIND, were introduced in Parts 1 and 2 of this series, respectively.
DATA SOURCES.  The current 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 outcomes in the NOC 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, CIC, 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 NOC will permit nursing researchers, among others, to conduct studies on nursing diagnoses in conjunction with the proposed novel nursing terminology, CIC.     

Case Study: Home Nursing Care for a 62-Year-Old Woman with Multiple Health Problems

PURPOSE.  This case study illustrates the characteristics of, and challenges for, a woman in the United States with multiple health problems.
DATA SOURCES.  Data were obtained through the authors' experience and knowledge of community health nursing and from published literature.
DATA SYNTHESIS.  NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification were utilized to identify appropriate nursing diagnoses, interventions, and outcomes for the client.
CONCLUSION.  This case study illustrates and provides appropriate nursing diagnoses, interventions, and outcomes relevant to a woman with many health concerns. It provides guidance for nurses in community health settings when caring for patients with multiple health problems.
IMPLICATIONS FOR NURSING PRACTICE.  Utilizing the standardized nursing languages of NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification can provide the necessary framework for enhancing and improving the management of care for patients with many health concerns in the community setting.     

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.     

Sexually Transmitted Disease in a Female Young Adult

PURPOSE. This case study demonstrates the sexual health challenges experienced by a woman newly married and recently migrated to the United States. DATA SOURCES. Data were obtained through the author's clinical experiences in primary healthcare nursing and published sources. DATA SYNTHESIS. The nursing diagnoses, nursing interventions, and patient outcomes for this woman were identified using the classifications of NANDA‐International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSION. This case study demonstrates the appropriate nursing diagnoses, interventions, and outcomes that are relevant for an individual with a sexually transmitted infection. It provides a framework for nurse practitioners in primary health care when caring for individuals with sexually transmitted infections. IMPLICATIONS FOR NURSING PRACTICE. Based on the NANDA‐International standardized nursing diagnoses, the Nursing Interventions Classification, and the Nursing Outcomes Classification provided the needed structure to improve the care of a woman with issues involving sexual health.     

Case Study: The Challenges of Self‐Management of Exacerbation of Pulmonary Symptoms

PURPOSE. This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self‐management for a female veteran. DATA SOURCES. Data were obtained through the author's clinical practice in primary care nursing and research literature sources. DATA SYNTHESIS. The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA‐International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSIONS. This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations. IMPLICATIONS FOR NURSING PRACTICE. Employing the NANDA‐International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

Case Study: Home Nursing Care for a 62‐Year‐Old Woman with Multiple Health Problems

PURPOSE. This case study illustrates the characteristics of, and challenges for, a woman in the United States with multiple health problems. DATA SOURCES. Data were obtained through the authors' experience and knowledge of community health nursing and from published literature. DATA SYNTHESIS. NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification were utilized to identify appropriate nursing diagnoses, interventions, and outcomes for the client. CONCLUSION. This case study illustrates and provides appropriate nursing diagnoses, interventions, and outcomes relevant to a woman with many health concerns. It provides guidance for nurses in community health settings when caring for patients with multiple health problems. IMPLICATIONS FOR NURSING PRACTICE. Utilizing the standardized nursing languages of NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification can provide the necessary framework for enhancing and improving the management of care for patients with many health concerns in the community setting.     

An Oncology Case Study Demonstrating the Use of Rogers's Science of Unitary Human Beings and Standardized Nursing Languages

PURPOSE.  The purpose of this paper is to present an oncology case study focusing on a woman's journey through breast cancer treatment and survivorship and a nurse's journey to provide wholistic care using standardized nursing languages and Rogers's Science of Unitary Human Beings (SUHB).
DATA SOURCES.  Published literature, experience, and expertise of the author were used as data sources.
DATA SYNTHESIS.  The data were clustered to formulate oncology nursing care based on the standardized nursing languages of NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification (NNN) from the theoretical foundation of Rogers's SUHB.
CONCLUSIONS.  The use of Rogers's SUHB, NNN, and the extant literature provided a theoretical, evidence-based, and practical approach to providing holistic care for a woman journeying through breast cancer treatment and survivorship.
IMPLICATIONS FOR NURSING PRACTICE.  Nurses can use standardized nursing languages and Rogers's SUHB to facilitate personal well-being and quality of life for breast cancer survivors.     

Using Standardized Nursing Languages in End‐of‐Life Care Plans

PURPOSE: This case study demonstrates the challenges to achieve dignified life closure and a comfortable death for a middle‐aged woman with terminal cancer and her family. DATA SOURCES: Data were obtained from a patient known through the author's clinical experiences, personal family experiences, and published sources. DATA SYNTHESIS: The appropriate nursing diagnosis, patient outcomes, and nursing interventions were identified through the use of NANDA‐International, the Nursing Outcomes Classification, and the Nursing Interventions Classification. CONCLUSIONS: This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with emotional distress at the end of life. IMPLICATIONS FOR NURSING PRACTICE: Employing the NANDA‐International standardized nursing diagnosis, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for considering and improving a dying patient's care in a primary and home setting.     

Determining Critical Incident Nursing Interventions for the Critical Care Setting: A Pilot Study

PURPOSE.  The purpose of this research survey was to determine which Adult Critical Care Core Nursing Interventions (ACCCNIs) in the Nursing Interventions Classification constitutes a critical incident nursing intervention (CINI). A CINI is defined as any indirect or direct care registered nurse (RN)-initiated treatment performed in response to a life-threatening nursing diagnosis.
METHODS.  A list of ACCCNIs were sent to 50 critical care RNs in two survey rounds. Responses >80% for each ACCCNI was determined to be a CINI.
FINDINGS.  Forty-one ACCCNIs were determined to be CINIs.
CONCLUSIONS.  It is recommended that CINIs be included as a separate Nursing Intervention Classification category to reflect current nursing practice.
IMPLICATIONS FOR NURSING PRACTICE.  CINIs can enhance RN competency, education, and vigilance, thereby preventing or decreasing the number of deaths that occur from critical incidents.     

A Validation Study of the Nursing Diagnosis Anxiety in Brazil

PURPOSE.  This study aims to validate the nursing diagnosis of anxiety among expert Brazilian nurses and clinicians using NANDA International defining characteristics and to compare the clinical judgments of the experts and the clinicians.
METHOD.  A semistructured questionnaire was completed by a convenience sample of 120 nurses. NANDA International defining characteristics of the Brazilian Portuguese version were used. The analysis of the ratings was based on the framework of the Diagnostic Content Validation model. Brazilian nurses considered the anxiety definition established by NANDA International to be appropriate and experts' and clinicians' judgments were similar for both groups of nurses.
FINDINGS.  The results showed that among the 71 characteristics of anxiety, 8 were identified as critical defining characteristics of anxiety (score  ≥  0, 80) by the expert nurses.
CONCLUSIONS.  Brazilian nurses accepted the NANDA International definition for nursing diagnosis of anxiety although some defining characteristics might differ due to cultural differences. Future research could address the limitations of the study and examine validations by both the experts and the clinicians.
IMPLICATIONS FOR NURSING PRACTICE.  The adequate preparation of undergraduate and postgraduate nurses in nursing diagnosis is important in improving the quality of care given to patients.     

Case Study: The Challenges of Self-Management of Exacerbation of Pulmonary Symptoms

PURPOSE.  This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self-management for a female veteran.
DATA SOURCES.  Data were obtained through the author's clinical practice in primary care nursing and research literature sources.
DATA SYNTHESIS.  The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification.
CONCLUSIONS.  This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations.
IMPLICATIONS FOR NURSING PRACTICE.  Employing the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

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.     

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.     

Perspective: Implementation of Nursing Language in Long-Term Care and Nursing Education

PURPOSE.  This article describes one nurse's experiences of returning to school after a 10-year absence, her introduction to nursing theory and terminology, and her subsequent implementation of nursing language in a long-term care setting and later experiences in teaching nursing language to students.
DATA SOURCES.  A 21-year career as a long-term care nurse coincided with the evolution of the new organization North American Nursing Diagnosis Association International, and she found herself in a position to implement nursing diagnosis in the long-term care setting. Practice experiences and pertinent nursing references and resources were used in clinical implementation and in teaching nursing students.
DATA SYNTHESIS.  The author reviewed the implementation and teaching of nursing language from a personal historical perspective.
CONCLUSIONS AND IMPLICATIONS FOR PRACTICE.  The author's experiences and perspectives on implementation of nursing language in clinical practice and in teaching provide information and a perspective for nurses and students involved in these processes.     

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.     

Ethical Dilemma and Moral Distress: Proposed New NANDA Diagnoses

PURPOSE: To propose two NANDA diagnoses--ethical dilemma and moral distress--and to distinguish between the NANDA diagnosis decisional conflict and the proposed nursing diagnosis of ethical dilemma. SOURCES USED: Journal articles, books, and focus group research findings. DATA SYNTHESIS: Moral/ethical situations exist in health care. Nurses' experiences of ethical dilemmas and moral distress are extrapolated to the types and categories of ethical dilemmas and moral distress that patients experience and are used as the basis for development of two new nursing diagnoses. CONCLUSION: The two proposed NANDA diagnoses fill a void in current standardized terminology. PRACTICE IMPLICATIONS: It is important that nurses have the ability to diagnose ethical or moral situations in health care. Currently, NANDA does not offer a means to document this important phenomenon. The creation of two sets of nursing diagnoses, ethical dilemma and moral distress, will enable nurses to recognize and track nursing care related to ethical or moral situations.     

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.     

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 Developmental Processes for NANDA International Nursing Diagnoses

PURPOSE: This study aims to provide a step-by-step procedural guideline for the development of a nursing diagnosis that meets the necessary criteria for inclusion in the NANDA International and NNN classification systems. DATA SOURCES: The guideline is based on the processes developed by the Diagnosis Development Committee of NANDA International and includes the necessary processes for development of Actual, Wellness, Health Promotion, and Risk nursing diagnoses. DATA SYNTHESIS: Definitions of Actual, Wellness, Health Promotion, and Risk nursing diagnoses along with inclusion criteria and taxonomy rules have been incorporated into the guideline to streamline the development and review processes for submitted diagnoses. CONCLUSIONS: A step-by-step procedural guideline will assist the submitter to move efficiently and effectively through the submission process, resulting in increased submissions and enhancement of the NANDA International and NNN classification systems.     

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.