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.     

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 .     

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 .     

Nursing diagnoses of hospitalized infants with physiologic hyperbilirubinemia: A cross sectional study

Background and aimNursing diagnoses are the common language of nurses which indicate the labels given to human responses to health problems/developmental processes. Neonatal physiologic hyperbilirubinemia is a developmental disorder common in neonates. The responses to this health problem need to be identified.This study aimed to find physiologic hyperbilirubinemia related nursing diagnoses in some domains of the NANDA-I classification in hospitalized newborns in a maternal-neonatal educational hospital in Tehran, Iran.MethodsIn this cross-sectional study, a checklist contains labels, defining characteristics and related factors of selected nursing diagnosis of six domains of the NANDA-I classification and a maternal-neonatal information questionnaire were used for conveniently selected 140 hospitalized newborns with physiologic hyperbilirubinemia. The data was analyzed using SPSS software 23 (IBM Corp, Armonk, NY).FindingsRisk for deficient fluid volume, Risk for electrolyte imbalance (hyponatremia/hypocalcemia/hypernatremia), risk for vascular trauma, risk for impaired skin integrity, risk for infection, risk for injury (retinal damage/bilirubin hyperbilirubinemia) and risk for thermal injury were the nursing diagnoses identified for more than 90% of the neonates.ConclusionThe nursing diagnoses identified in this study for physiologic neonatal hyperbilirubinemia can guide clinical neonatal nurses in providing high-quality care in neonatal settings.     

ICU医疗器械相关性压力性损伤闭环管理系统的构建及应用

目的 构建ICU医疗器械相关性压力性损伤（medical device-related pressure injuries,MDRPI）闭环管理系统,探讨其在临床中的应用效果。 方法 构建由风险评估、临床护理决策、质量与安全管理模块组成的ICU MDRPI闭环管理系统,于2019年7月在广东省某三级甲等医院ICU病房中使用,比较闭环管理系统应用前后6个月患者入ICU时MDRPI评估率、MDRPI住院评估率、MDRPI高风险患者筛查率、临床护理决策实施率、MDRPI发生率。 结果 闭环管理系统应用后,患者入ICU时MDRPI评估率从64.3%上升至96.8%,MDRPI住院评估率从44.9%上升至98.2%,MDRPI高风险患者筛查率从51.3%上升至98.9%,临床护理决策实施率从39.6%上升至95.8%,MDRPI发生率从15.9%下降至7.3%,差异均具有统计学意义﹙P<0.001﹚。 结论 ICU MDRPI闭环管理系统能帮助ICU护士科学、客观地评估MDRPI,并作出合理的护理决策,可规范MDRPI管理流程,有效降低MDRPI发生率。     

The Critical Nursing Situation Index for safety assessment in intensive care

OBJECTIVE: The assessment of critical nursing situations can be a valuable tool in the detection of weak elements in the safety of patients and the quality of care in the ICU. A critical nursing situation can be defined as any observable situation, which deviates from good clinical practice and which may potentially lead to an adverse event. The aim of our study was to establish the feasibility, reliability and validity of the Critical Nursing Situation Index (CNSI) as a tool for assessing the safety and the quality of nursing in the ICU. DESIGN: We described the deviations from standards and protocols in daily ICU nursing care, selected those with an implicit, clear risk for the patients and translated them into explicitly observable items. If an item was applicable during observation of the ICU practice, a critical nursing situation could be recorded as either true or false. The reliability of the CNSI was defined in terms of inter-observer agreement. The validity was assessed by exploring the relationship between the nursing time available (more or less than 30 min per patient per hour) and the incidence of critical nursing situations. SETTING: The study was performed in the ICU of a teaching hospital (30 IC beds) in which all disciplines, including cardiothoracic surgery and neurosurgery, were represented. PATIENTS: The CNSI was randomly applied to 83 ICU patients over a period of 3 months (200 times). MEASUREMENTS AND RESULTS: The reliability of the index was substantial (Kappa values in the range > or =0.70 to > 0.80). In terms of validity, less nursing time resulted in more critical situations (pooled relative risk (RR) 1.36; 95% confidence limits 1.11/1.67). CONCLUSION: The CNSI is simple to use and has encouraging metric properties, whereas the assessments are closely related to direct patient care. Moreover, the CNSI provides a tool for safety assessment by monitoring potentially dangerous situations that are generally regarded as needing to be avoided.     

Nursing diagnoses: a study of cultural relevance.

This study examines the adequacy/inadequacy of three nursing diagnoses with cultural etiologies: (1) impaired verbal communication related to cultural differences; (2) impaired social interaction related to sociocultural dissonance; and (3) noncompliance related to patient value system. The research tool was administered to the membership of the American Nurses Association Council on Cultural Diversity and the International Transcultural Nursing Society, with a response rate of N = 245 (42.2 per cent) from 43 states, the District of Columbia, and seven foreign countries. The tool listed the North American Nursing Diagnosis Association (NANDA) defining characteristics and cultural etiology for each diagnosis rated on a five-point Likert scale from "nearly always present" to "rarely present." The subjects also wrote and ranked other defining characteristics they used to make the diagnosis in clinical practice. Percentage distribution results indicate no defining characteristic meets the NANDA criteria for a major or minor defining characteristic. By collapsing categories, seven were acceptable only as minor defining characteristics. Respondents' 113 suggestions for additional characteristics were content analyzed. Themes for 12 categories were intuited and added to the lists. Based on respondents' suggestions, the definitions for each diagnosis were reworked, and new cultural-related factors were added. The cultural adequacy/inadequacy of elements within these three diagnoses was identified and provides the opportunity for greater selectivity in their clinical use. Additional suggestions from transcultural nursing experts form a data base for future research to expand the use of the currently limited components of NANDA diagnoses with culturally diverse patients.     

Risk factors for prolonged stay in cardiac surgery intensive care units

Aims and objectives: To identify the factors that might affect the length of stay in the intensive care unit (ICU‐LOS) among cardiac surgery patients. Background: ICU‐LOS forms an important factor for assessing the effectiveness of the provided nursing care. A number of factors can be accused for increasing patient hospitalization. The nursing workload (NWL), among others, was found to play a significant role as it is closely associated with the quality of care. Design: An observational cohort study among 313 consecutive patients who were admitted to the cardiac surgery intensive care unit of a general, tertiary hospital of Athens, Greece from November 2008 to November 2009. Methods: Data collection was performed by using a short questionnaire (for basic demographic information) and two instruments, the Nursing Activities Score (NAS) and the logistic EuroSCORE, for assessing the NWL and the perioperative risk for each patient respectively. Results: ICU‐LOS of more than 2 days increased with age and was more common among females (p < 0·001 and p = 0·02, respectively). Multivariate logistic regression analysis revealed a positive association between increased perioperative risk and the increased ICU‐LOS [odd ratio (OR) 1·9, 95% confidence interval (CI) 1·0–3·5, p = 0·04], while patients with a first day NAS of more than 61·6% had an almost 5·2 times greater probability to stay in the cardiac surgery unit for more than 2 days (OR 5·2, 95% CI 3·0–8·8, p < 0·001). Conclusions: Increased level of NWL and patient perioperative risk are closely associated with increased ICU‐LOS. Relevance to clinical practice: The correlation between patient perioperative risk and ICU‐LOS encourages the early identification of high‐risk patients for prolonged hospitalization. Furthermore, the relationship between NWL and ICU‐LOS allows the early identification of these patients with the use of an independent nursing tool.     

预防ICU内中心静脉导管相关血流感染的护理研究进展

中央导管相关血流感染在ICU内是一种常见的并发症,本研究特指由中心静脉导管(Central Venous Catheter,CVC)引起的相关血流感染,这种并发症不仅会延长患者住院时间、增加患者的死亡风险和病症的医疗费用,还会给医护人员的工作带来极大的负担。近年来,以改善ICU内中央导管置管患者安全和预后结局的研究越来越多。本文从护理循证实践的角度就ICU内中央导管相关血流感染的相关概念、发生机制、危险因素、诊断要点和护理实践措施等进行阐述,以期为ICU临床护理实践和相关研究的开展提供参考。     

Adult intensive care unit use at the end of life: a population-based study

OBJECTIVES: To determine population-based rates of intensive care unit (ICU) use at the end of life in adults and describe demographic and clinical variation in end-of-life ICU use. PATIENTS AND METHODS: A retrospective, population-based cohort study set in Olmsted County, Minnesota, was performed. We identified adult residents admitted to an ICU in 1998 and determined those who were in the last year of life. Demographic data, ICU admission diagnoses, ICU Interventions, and length of stay were collected. We obtained Charlson comorbidity diagnoses and Indices for residents of Olmsted County to calculate condition-specific rates of end-of-life ICU use. RESULTS: Of the 818 residents who had an ICU admission in 1998, 90 died in either the ICU or the hospital after having received ICU care. One in 8 decedents from Olmsted County in 1998 received ICU care during a terminal hospital admission. Six-month decedents who had received ICU care were older, had longer lengths of stay, and had a higher degree of comorbid illness compared with 6-month survivors. The ICU admission rates in the last 6 months of life increased with age and number of chronic conditions, ranging from 0.26 per 1000 person-years in the 18- to 44-year-old group to 18.5 per 1000 person-years in those 85 years or older and from 0.34 per 1000 person-years in those with no chronic conditions to 302.1 per 1000 person-years in those with 5 or more chronic conditions. CONCLUSION: The rate of ICU use at the end of life Increases significantly with age and with the number of coexisting chronic illnesses.     

Perioperative nurses' attitudes toward the use of nursing diagnoses in documentation

AIM: This paper reports a study of nurses' attitudes towards the use of nursing diagnoses in perioperative documentation and the factors affecting these attitudes. BACKGROUND: There are both international and national requests for nurses to move from natural language-based narrative documentation to electronic documentation and clinical use of nursing classifications. However, nurses' attitudes toward nursing classifications have not been widely studied. METHODS: A questionnaire was distributed to a purposive sample of perioperative nurses (n = 146) who had participated in clinical testing of nursing diagnoses. The response rate was 60% (n = 87). The data were collected in 2003. RESULTS: In general, nurses' attitudes toward nursing diagnoses were positive. Those over 40 years of age who had clinical experience from 10 to 19 years, postbasic nursing education and previous knowledge of nursing diagnoses were most positive in their attitudes. However, the use of nursing diagnoses in perioperative practice was not seen as either necessary or accurate in describing patients' problems. Furthermore, the documentation of perioperative routines was seen as time-consuming and frustrating. CONCLUSIONS: Nursing classifications should be included in both preregistration nursing curricula and in-service educational programmes to ensure theoretical knowledge of and practical skills in standardized clinical languages. The perioperative nursing diagnoses should be reviewed to fit better with clinical practice. In addition, current perioperative documentation practices should be reconsidered and updated as appropriate to address clinical requirements better.     

Nursing Diagnoses in Children With Congenital Heart Disease: A Survival Analysis

PURPOSE: To analyze the relationship between nursing diagnoses and survival rates in children with congenital heart disease. METHODS: A total of 270 observations were carried out in 45 children with congenital heart disease who were followed for 15 days. FINDINGS: Differences in mean survival times were identified in children not more than 4 months of age with respect to the following diagnoses: impaired gas exchange, ineffective breathing pattern, activity intolerance, delayed growth and development, and decreased cardiac output. CONCLUSIONS: The main diagnoses are identified early in the hospitalization period and are conditions resulting from hemodynamic alterations and prescribed medical treatment. IMPLICATIONS FOR NURSING PRACTICE: Congenital heart disease provokes serious hemodynamic alterations that generate human responses, which should be treated proactively.     

建立临床科室护理岗位风险度评估体系的研究

[目的]建立和完善临床科室护理岗位风险度评估体系,推行体现高风险、高责任、高技术的岗位和护理人员劳动价值的激励机制。[方法]对近两年内临床科室护理进行秩和比分析,测评不同护理岗位的风险度。[结果]综合评分排名前三位的科室分别是综合ICU、神经外科和急诊内科。[结论]护理岗位风险度和绩效考核评估体系,对护理人力资源的配置指导、绩效考核和向高风险岗位倾斜政策的制订提供了有力的依据。