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.     

Respiratory Nursing Diagnoses: Practicing Nurses' Selection of Defining Characteristics

One-hundred medical/surgical nurses from two hospitals participated in a study designed to determine which defining characteristics professional nurses working in acute-care settings associated with each of the three respiratory nursing diagnoses identified by the North American Nursing Diagnosis Association (NANDA). All NANDA defining characteristics for impaired gas exchange and ineffective airway clearance were selected by at least 63% and 67% of the study participants, respectively. Thirteen of the 15 NANDA defining characteristics for ineffective breathing pattern were selected by at least 68% of the study participants. Two characteristics of ineffective breathing pattern identified by NANDA, cough and fremitus, were selected by only 47% and 45% of respondents. This study was the first in a series of studies intended to validate the respiratory nursing diagnoses.     

Accuracy of Nurses' Diagnoses of Psychosocial Responses

PURPOSE. To describe the accuracy of staff nurses' diagnoses or interpretations of the human responses of patients in hospital settings.
METHODS. The sample was 62 staff nurses in three hospitals who assessed and diagnosed the psychosocial problems of one to four patients. Two trained raters followed with assessment, diagnosis, and ratings of nurses' accuracy of 153 cases. A seven-point interval scale was used to judge accuracy.
FINDINGS. The means of accuracy scores across nurses were significantly different (f = 1.66; p<.05; df = 2,59). A significant percentage of nurses' diagnoses were scored at the two highest levels of accuracy (45.2%), and 12.8% were scored at the three lowest levels of accuracy. According to the expert raters, a high percentage of patients (54.4%) were experiencing fear or anxiety.
CONCLUSIONS. More attention needs to be given to the accuracy of nurses' diagnoses of psychosocial responses.     

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.     

Evaluation of Admission Nursing Diagnoses

Despite the interest and research in nursing diagnosis, few studies have examined the incidence and quality of the diagnoses. Specifically, a lack of knowledge exists regarding what nursing diagnoses are formulated on a patient's admission to the hospital Data from the charts of 33 adult orthopedic patients were evaluated for the type, frequency, and quality of admission nursing diagnoses. Of the 106 nursing diagnoses written, approximately two-thirds were on the accepted list of the North American Nursing Diagnosis Association (NANDA) at the time of the study (1988). Alteration in comfort was the most prevalent diagnostic label. The quality of the diagnoses was evaluated using Ziegler's (1984) tool Only one diagnosis, potential alteration in skin integrity related to bedrest. met all 12 criteria. Nurses showed more difficulty in correctly identifying the etiology component than the response component of the diagnostic statement. Factors that affect the quality of nursing diagnoses and the need for tool refinement are discussed, and research recommendations are made.     

Validation of Nursing Management Diagnoses

Nursing management diagnosis based on nursing and management science, merges "nursing diagnosis" and "organizational diagnosis". Nursing management diagnosis is a judgment about nursing organizational problems. The diagnoses provide a basis for nurse manager interventions to achieve outcomes for which a nurse manager is accountable. A nursing organizational problem is a discrepancy between what should be happening and what is actually happening that prevents thegoals of nursing from being accomplished. The purpose of this study was to validate 73 nursing management diagnoses identified previously in 1992: 71 of the 72 diagnoses were considered valid by at least 70% of136 participants. Diagnoses considered to have high priority for future research and development were identified by summing the mean scores for perceived frequency of occurrence and level of disruption. Further development of nursing management diagnoses and testing of their effectiveness in enhancing decision making is recommended.     

Contexts for the Study of the Economic Influence of Nursing Diagnoses on Patient Outcomes

PURPOSE: To examine the historical, legal/ organizational, informatics, clinical, economic, and policy contexts underlying economic consequences of nursing diagnoses on patient outcomes. DATA SOURCES: Published literature, online material. DATA SYNTHESIS: Nursing diagnoses influence diagnostic-specific patient outcomes and other outcome variables such as length of hospital stay, morbidity, and mortality. CONCLUSIONS: Examination of the economic ramifications of nursing diagnosis on patient outcomes can be facilitated using standardized language and databases containing nursing-sensitive measures.     

Nursing Diagnoses for Hospitalized Patients With AIDS

This study examined the reliability of nursing diagnoses identified from the medical records of 100 patients hospitalized for HIV disease on a 22-bed designated unit at a large metropolitan teaching hospital in Los Angeles. The diagnoses were identified in two ways: (a) staff nurses identified 16 different nursing diagnoses using preprinted care plans found in the medical records, with 2 to 9 problems per patient (M = 4.8 , SD = 1.6 ) and (b) the nurse researcher-identified 45 different nursing diagnoses derived from defining characteristics documented in the medical records, with 1 to 9 identified problems per patient (M = 3.3 , SD = 1.8 ) . The most frequent problems identified were the same as those addressed in the clinical literature: pain, respiratory problems, nutritional deficits, and psychosocial concerns. The results of this study raise concerns about the limitations of nursing diagnosis research using existent data bases and the use of preprinted care plans .     

Noun Phrases for Nursing Diagnoses

TOPIC. The use of noun phrases for nursing diagnoses instead of the current mixture of phrases and clauses
PURPOSE. This article reviews the current list of qualifiers; discusses language clarity, precision, grammatical concerns; and defines noun phrases.
SOURCE. Literature review
CONCLUSIONS. The author proposes a list of qualifiers to replace the current list, and recommends a revised list of nursing diagnoses using noun phrases to improve their clinical usefulness, allow for alphabetization, and enhance clarity.     

Accuracy of Nursing Diagnoses: Concept Development

The concept of accuracy of nursing diagnoses was developed by the author as a first step of theory development related to nursing diagnosis. Accuracy is conceptually redefined as a continuous variable and as such contrasts with the prevailing view of accuracy that diagnoses are either accurate or inaccurate. The conceptual definition of accuracy of a nursing diagnosis and a delineation of the characteristics of accuracy emphasize the relativistic nature of the concept.