Improved Quality of Nursing Documentation: Results of a Nursing Diagnoses, Interventions, and Outcomes Implementation Study

PURPOSE: To evaluate the impact of the quality of nursing diagnoses, interventions, and outcomes in an acute care hospital following the implementation of an educational program. METHOD: In a pretest-posttest experimental design study, nurses from 12 wards of a Swiss hospital received an educational intervention--an introductory class and consecutive classes, using a case discussion method--to implement nursing diagnoses, interventions, and outcomes. Two sets of 36 randomly selected nursing records were evaluated before and after implementation. The quality of documented nursing diagnoses, interventions, and nursing-sensitive patient outcomes was assessed by 29 Likert-type items with a 0-4 scale instrument, called Quality of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO) and tested using t-tests. FINDINGS: Significant enhancements in the quality of documented nursing diagnoses, interventions, and outcomes were found following the implementation of a planned educational program. CONCLUSIONS: The implementation of NANDA, NIC, and NOC (NNN) nursing diagnoses, interventions, and outcomes led to higher quality of nursing diagnosis documentation, etiology-specific nursing interventions, and nursing-sensitive patient outcomes. IMPLICATIONS FOR NURSING PRACTICE: Educational measures support nurses to improve documentation of diagnoses, interventions, and outcomes. The Q-DIO is a useful audit tool.     

Evaluation of the Implementation of Nursing Diagnoses, Interventions, and Outcomes

PURPOSE.  This paper aims to provide insight into nursing classifications and to report the effects of nursing diagnostics implementation. This paper summarizes the results of six studies.
METHODS.  Two systematic reviews, instrument development and testing, a pre–post intervention study, and a cluster-randomized trial were performed.
FINDINGS.  The NANDA International classification met most of the literature-based classification criteria, and results showed the Quality of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) to be a reliable instrument to measure the documented quality of nursing diagnoses, interventions, and outcomes. Implementation of standardized nursing language significantly improved the quality of documented nursing diagnoses, related interventions, and patient outcomes. As a follow-up measure, Guided Clinical Reasoning (GCR) was effective in supporting nurses' clinical reasoning skills.
CONCLUSIONS.  Carefully implementing classifications led to enhanced, accurately stated nursing diagnoses, more effective nursing interventions, and better patient outcomes.
IMPLICATIONS.  Rethinking implementation methods for standardized language and using GCR is recommended. Based on the results of this study, the inclusion of NANDA International diagnoses with related interventions and outcomes in electronic health records is suggested.     

Cross‐Cultural Adaptation of the Quality of Diagnoses,Interventions and Outcomes (Q‐DIO) Instrument into Brazilian Portuguese

PURPOSE: To describe the cross‐cultural adaptation of the Quality of Diagnoses, Interventions and Outcomes instrument into Brazilian Portuguese. METHOD: This process entailed translation, synthesis, back‐translation, expert committee review, and pretesting. FINDINGS: Six items were altered in the Brazilian version, and the scoring system was changed from a five‐point to a three‐point Likert‐type scale. Pretesting was conducted on a sample of 40 randomly selected nursing records. Overall reliability as measured by Cronbach's alpha was 0.96. CONCLUSIONS: Adaptation resulted in a preliminary version of the instrument. IMPLICATIONS FOR NURSING PRACTICE: Assessment of the psychometric properties of the instrument in a larger sample of nursing records is required, and such a study is underway.