Use of the Nursing Minimum Data Set to Describe Nursing Interventions for Select Nursing Diagnoses and Related Factors in an Acute Care Setting

This study describes the prevalence of nursing interventions across six nursing diagnoses and their related factors using the framework of the Nursing Minimum Data Set (NMDS). Six nursing diagnoses (pain, potential for injury, anxiety, decreased cardiac output, potential for infection, and knowledge deficit) were among the most prevalent in an acute care setting studied in 1992. The NMDS and a nursing information system using standardized classification systems for nursing diagnoses and interventions provided an opportunity to describe nursing practice. Multiple related factors were identified across all six nursing diagnoses; three or four were selected frequently within each diagnostic category. The related factors also influenced the selection of interventions. Implications for the development of nursing classification systems and recommendations for further research are described .     

Nurse autonomy,nurse job satisfaction and client satisfaction with nursing care: their place in nursing data sets

Many changes have taken place in the healthcare system that have influenced nurse autonomy, job satisfaction and client satisfaction. Standardized language facilitates communication within the discipline of nursing. Examples of such language include the Nursing Intervention Classification (NIC) and the Nursing Outcomes Classification (NOC) systems as well as the Nursing Minimum Data Set (NMDS), which provides a formal structure for electronic data sets to support nursing care. The Nursing Management Minimum Data Set (NMMDS) was designed to identify variables to guide nurse managers in evaluating the impact of nursing interventions on client outcomes. Gaps within NMDS and NMMDS are discussed, and solutions are proposed.     

Validity and reliability of the Nursing Minimum Data Set for the Netherlands (NMDSN)

The Nursing Minimum Data Set for the Netherlands (NMDSN) describes nursing care based on nursing phenomena, interventions and outcomes. The validity and reliability of its data collection has not been tested yet. PURPOSE: To report about the discriminative validity and the interrater reliability of the NMDSN. DESIGN: Data were collected in an intensive care ward, in a nursing home and in a residential home. The unit of measurement and analysis is the 'patient day'. The analysis for validity consisted of ridits calculations, and their graphical representations. Interrater reliability was measured by percentage agreement and Cohen's kappa. RESULTS: Graphs illustrate the differences on most nursing phenomena and interventions as expected beforehand. The percentage agreements for the residential home vary from 60.4 to 100%, and the kappa statistics from -0.09 to 0.85, indicating a poor to almost perfect interrater reliability. CONCLUSION: Intensive care patients and patients in the nursing home have more problems and need more nursing interventions compared with general hospital patients, while the patients in the residential home have lesser of both. This illustrates the discriminative validity of the NMDSN. The kappa values for various NMDSN variables are sufficient. A similar test in the general hospital is recommended.     

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items Rationale Currently, there is no systematic collection of nursing care data in the Netherlands, while pressure is growing from the profession, policy-makers and society to justify the contribution of nursing and its costs. A nursing minimum data set can provide data to demonstrate nursing's contribution to health care as it can be used to describe the diversity of different patient populations and the variability of nursing activities, and to calculate the associated nursing workload. Objective To identify categories and items for inclusion in the Nursing Minimum Data Set for the Netherlands. Design A multimethod, exploratory approach was used. This included interviews, document analysis, consensus rounds, seeking validation in the literature, and drawing up lists of most frequently occurring patient problems, interventions and outcomes of care. Eight hospitals, with a total of 16 wards, participated in the study. Results Relevant categories and items emerged after analysis and grouping of the material and included: five hospital-related items, six patient demographics items, seven medical condition items, 10 nursing process items, 24 patient problems, 32 nursing interventions, four outcomes of nursing care, and three complexity of care items. Almost every item could be located in the existing documentation systems, the lists of patient problems, outcomes and interventions, or in the literature. Conclusion A set of categories and items of nursing data has been identified. The content validity of this set is partly supported by its consistency with the literature, findings from practice and the judgement of potential users. Nursing outcomes need further development. The data set will be tested in practice to find out whether the categories and items are useful, and whether they can be minimized.     

An Analysis of Nursing Diagnoses for Patients Undergoing Procedures in a Brazilian Interventional Radiology Suite

Innovations in minimally invasive surgery have led to more procedures being performed in the interventional radiology suite. It, therefore, is essential that nurses in radiology departments be competent to care for all types of patients. Use of nursing classification systems can improve care by providing standardized language for documentation. We conducted a project that involved 25 patients undergoing interventional radiology procedures between August and October 2006 in São Paulo, Brazil, to identify the most frequent North American Nursing Diagnosis Association (NANDA) nursing diagnoses used and then compared the NANDA diagnoses to Perioperative Nursing Data Set diagnoses. The most frequent nursing diagnoses in the participants were anxiety, chronic pain, inefficient tissue perfusion-peripheral, deficient knowledge, and risk for falls. These results are similar to diagnoses that have been reported in outpatient centers. The NANDA and Perioperative Nursing Data Set diagnoses were found to be similar.     

Use of NIDSEC-compliant CIS in community-based nursing-directed prenatal care to determine support of Nursing Minimum Data Set objectives

If the Nursing Minimum Data Set elements, specifically the nursing care elements, are included in a clinical information system, nursing will be able to measure outcomes and contributions to both healthcare and nursing to build knowledge using clinical data. The purpose of the reported study was to determine whether a Nursing Information and Data Set Evaluation Center-compliant clinical information system using the Omaha System could support the Nursing Minimum Data Set goal to describe nursing care in a community health setting. The secondary data set analysis was conducted. The findings showed that although the clinical information system was compliant with the standard, used a recognized American Nurses Association nursing vocabulary, and supported the collection of the Nursing Minimum Data Set, the data were not sufficient to address the purposes of the Nursing Minimum Data Set. The implications for nursing research and clinical practice are outlined.     

Nursing Intervention Classification Systems

Purpose: To analyze the features, development, and research of the Omaha System, the Iowa Nursing Intervention Classification, and the Home Health Care Classification and provide a critical review of the unique components of each.
Organizing Framework: Five elements: achievement of original purpose, language used, ease of computerizing format, clinical utility, and linkage of the Nursing Minimum Data Set (NMDS) nursing care elements.
Conclusions: Further testing and development of nursing classification systems should be done to determine the general value of nursing classification, the extent to which the original goals and purposes of classification are met, and to identify the unique features and contributions of each system. Further testing is important to determine the strengths, weaknesses, and applicability of the various systems for capturing the elements of the NMDS for different care settings, care givers, and patient populations.
Implications: Nursing classification may eventually lead to naming and describing the work of nurses. Research findings will continue to provide information leading to a unified nursing language system that describes the practice of nursing in local, regional, national, and international health-care data sets used for research, clinical, education, policy, and administrative purposes.     

Preparing a large data set for analysis: using the minimum data set to study perineal dermatitis

AIM: The aim of this paper is to present a practical example of preparing a large set of Minimum Data Set records for analysis, operationalizing Minimum Data Set items that defined risk factors for perineal dermatitis, our outcome variable. BACKGROUND: Research with nursing home elders remains a vital need as 'baby boomers' age. Conducting research in nursing homes is a daunting task. The Minimum Data Set is a standardized instrument used to assess many aspects of a nursing home resident's functional capability. United States Federal Regulations require a Minimum Data Set assessment of all nursing home residents. These large data would be a useful resource for research studies, but need to be extensively refined for use in most statistical analyses. Although fairly comprehensive, the Minimum Data Set does not provide direct measures of all clinical outcomes and variables of interest. METHOD: Perineal dermatitis is not directly measured in the Minimum Data Set. Additional information from prescribers' (physician and nurse) orders was used to identify cases of perineal dermatitis. The following steps were followed to produce Minimum Data Set records appropriate for analysis: (1) identification of a subset of Minimum Data Set records specific to the research, (2) identification of perineal dermatitis cases from the prescribers' orders, (3) merging of the perineal dermatitis cases with the Minimum Data Set data set, (4) identification of Minimum Data Set items used to operationalize the variables in our model of perineal dermatitis, (5) determination of the appropriate way to aggregate individual Minimum Data Set items into composite measures of the variables, (6) refinement of these composites using item analysis and (7) assessment of the distribution of the composite variables and need for transformations to use in statistical analysis. RESULTS: Cases of perineal dermatitis were successfully identified and composites were created that operationalized a model of perineal dermatitis. CONCLUSION: Following these steps resulted in a data set where data analysis could be pursued with confidence. Incorporating other sources of data, such as prescribers' orders, extends the usefulness of the Minimum Data Set for research use.     

Updating and normalization of the Nursing Management Minimum Data Set element 6: patient/client accessibility

Patient/client accessibility is one of 18 Nursing Management Minimum Data Set data elements developed to evaluate contextual factors at the nursing unit or service level of care. The Nursing Management Minimum Data Set 06 patient/client accessibility was developed to capture variability in time and distance required to access patients. Variability in access to patients, needed supplies, equipment, and information for patient care has an impact on the amount of time available for direct patient care. Limitations in time available to provide safe and quality care may negatively affect patient outcomes, nurse retention, and, as a result, a healthcare organization's accreditation and finances. Since 2005, the first five Nursing Management Minimum Data Set data elements have been incorporated into the publicly accessible healthcare data set Logical Observation Identifier Names and Codes, thereby making results derived from these nursing management data elements available for empirical use. A critical review of the literature and other healthcare resources was conducted to update patient/client accessibility. A consensus approach was used by an interdisciplinary panel of experts to finalize recommendations for revisions. The name, conceptual and operational definitions, and measures were updated. The revised data element is titled "client accessibility." The conceptual and operational definitions were expanded and measures changed to increase validity and reliability of data collection. The updated conceptual definition is "the time, distance, and method to connect the nurse/provider and client for an encounter and includes the information, supplies, equipment, and personnel required for the encounter." The Nursing Management Minimum Data Set can provide individuals responsible for managing and financing nursing resources with quantifiable data regarding the context of nursing care. At present, healthcare costs are rising at an unsustainable rate, and many national healthcare outcomes are worsening. More information is needed to identify potential areas of improvement in the management and funding of nursing care. The update and use of Nursing Management Minimum Data Set 06 data element client accessibility may help to identify problem areas associated with nursing time, distance traveled, and methods used to provide patient care. Such empirical evidence may support better informed decisions on caseloads in diverse settings, hospital designs, methods used to provide care, and fiscal requirements.     

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.     

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.     

Nursing diagnoses, interventions and outcomes - application and impact on nursing practice: systematic review

AIM: This paper reports a systematic review on the outcomes of nursing diagnostics. Specifically, it examines effects on documentation of assessment quality; frequency, accuracy and completeness of nursing diagnoses; and on coherence between nursing diagnoses, interventions and outcomes. BACKGROUND: Escalating healthcare costs demand the measurement of nursing's contribution to care. Use of standardized terminologies facilitates this measurement. Although several studies have evaluated nursing diagnosis documentation and their relationship with interventions and outcomes, a systematic review has not been carried out. METHOD: A Medline, CINAHL, and Cochrane Database search (1982-2004) was conducted and enhanced by the addition of primary source and conference proceeding articles. Inclusion criteria were established and applied. Thirty-six articles were selected and subjected to thematic content analysis; each study was then assessed, and a level of evidence and grades of recommendations assigned. FINDINGS: Nursing diagnosis use improved the quality of documented patient assessments (n = 14 studies), identification of commonly occurring diagnoses within similar settings (n = 10), and coherence among nursing diagnoses, interventions, and outcomes (n = 8). Four studies employed a continuing education intervention and found statistically significant improvements in the documentation of diagnoses, interventions and outcomes. However, limitations in diagnostic accuracy, reporting of signs/symptoms, and aetiology were also reported (14 studies). One meta-analysis of eight trials including 1497 patients showed no evidence that standardized electronic documentation of nursing diagnosis and related interventions led to better nursing outcomes. CONCLUSION: Despite variable results, the trend indicated that nursing diagnostics improved assessment documentation, the quality of interventions reported, and outcomes attained. The study reveals deficits in reporting of signs/symptoms and aetiology. Consequently, staff educational measures to enhance diagnostic accuracy are recommended. The relationships among diagnoses, interventions and outcomes require further evaluation. Studies are needed to determine the relationship between the quality of documentation and practice.     

Admissions to skilled nursing facilities from assisted living facilities

Minimum Data Set data from 15,977 residents were analyzed to investigate the reasons older adults were admitted to skilled nursing facilities from assisted living facilities. Residents admitted from assisted living facilities, private homes, hospitals, and hospitals with previous assisted living facility residence were compared. Findings suggest that residents admitted from assisted living facilities are more likely to be older, to have diagnoses of dementia and depression, and to be placed in Alzheimer's special care units.     

Permanent transition of homecare recipients with dementia to nursing homes in New York State: Risk factors

This retrospective cohort study uses the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) to determine predictors associated with permanent transition to nursing homes among home care recipients with dementia. Study participants include older adults age 65+ with dementia who received home health services in New York State for at least 2 months prior to permanent transition to nursing homes. Multivariate logistic regression was used to quantify the association between predictors and permanent transition to nursing homes. Risk factors associated with permanent transition included increasing age (OR = 1.1; 95% CI 1.03-1.18); white compared to black (OR = 1.25; 95%CI 0.83-0.94), urinary and bowel incontinence vs. continence (OR = 1.46; 95% CI 1.37-1.56); depression vs. no depression (OR = 1.2; 95% CI 1.11-1.25); hip fracture vs. no hip fracture (OR = 2.63; 95% CI 2.27-3.05), and 3+ hospitalizations vs. no hospitalizations (OR = 3.02; 95% CI 2.77-3.29). Early diagnosis and treatment may delay or avert nursing home entry.     

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.     

Measuring the intensity of nursing care: making use of the Belgian Nursing Minimum Data Set

BACKGROUND: The Belgian Nursing Minimum Data Set (B-NMDS) is a nationwide registration of 23 nursing activities. It was developed for the measurement of nursing care in acute hospitals. It is used to support healthcare management & policy decision making such as hospital financing and nurse staffing decisions. OBJECTIVE: To develop a measure of the intensity of nursing care based on information that is available in the B-NMDS. DESIGN-SETTING-PARTICIPANTS: Retrospective analysis of the B-NMDS from all Belgian acute hospitals (n=115) for the year 2003. The sample included 690,258 inpatient days for 298,691 patients that were recorded from 1637 acute care nursing units. METHODS: The 23 nursing activities were synthesized into one new latent variable by PRINQUAL analysis. This variable was evaluated as a measure of nursing care intensity using key characteristics of the San Joaquin patient classification system, which was designed to measure the intensity of nursing care. RESULTS: The main NMDS component from the PRINQUAL analysis accounted for 26.8% of the variance. The distribution of inpatient days over all four San Joaquin categories is: 11.1% (self-care); 40.4% (average care); 30.8% (above average care); 17.7% (intensive care). In 97.5% of the nursing units the intensity of nursing care score of the B-NMDS (main NMDS component) followed the ordinality of the San Joaquin classification system. Furthermore, the San Joaquin categories alone explained more variability--70.2% in the intensity of nursing care measure (main NMDS component) than did other determinants, such as department type, age, diagnostic-related groups (DRG) and severity of illness, hospital type and hospital size together. CONCLUSION: The B-NMDS is an instrument that produces a measure of the intensity of nursing care in acute hospitals.     

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.     

Development of a nursing data set for school nursing.

School nurses need to clearly identify how they promote the health and educational achievement of children. School nurses contribute to student health by providing health assessment and nursing interventions, advocating for healthy living, and contributing to prevention of illness and disease management. A Nursing Data Set for School Nursing can identify those data elements that are needed to prove that school nurses have a positive effect on children, families, and the community. The purpose of this project was to develop a Nursing Data Set for School Nursing that would describe and validate school nursing practice. Building on the Nursing Minimum Data Set developed by Werley, Devine, and Zorn, a Nursing Data Set for School Nursing was developed with guidance from experts in the field of school nursing. A Nursing Data Set for School Nursing has the potential to assist school nurses in documentation and validation of their nursing practice. It can validate the complexity of the role of the school nurse, the resources needed, and the effect school nurses have on improving the health and educational outcomes of students.