Accurate Nursing Diagnosis Research Articles

The quality of nursing documentation and standardized nursing diagnoses in the children's hospital electronic nursing records.

The aim of the paper is to compare the quality of nursing documentation in the Children's Hospital before and after the NANDA-I nursing diagnoses training. Research employed the interventional study design, and pre-post study design. Before and after the NANDA-I nursing diagnoses training, 50 nursing records were analyzed in the interventional pre-post study, using D-Catch instrument. The most often documented problem-centered nursing diagnosis before training was anxiety and after the training, hyperthermia. The most common risk diagnoses before and after the training was risk of infection. Before the training, one health promotion diagnosis was determined in the nursing records, and after the training the number increased to four. The highest value was given to readability of the nursing documentation both before and after the training. The lowest score before the training was given to the quality determiners of the accurate nursing diagnoses and after the training given to the determiners of the results' quantity. The sum score of documenting the nursing interventions was the most inconsistent before the training and after the training. The most consistent was the readability of the nursing records before and after the training. Statistically significant differences in the improvement of quality were revealed in all areas except for the readability of the nursing documentation and the quantity of nursing assessment. The results of the study revealed that following the training, the quality of nursing documentation improved, the wording of the nursing diagnoses improved, and the number of accurate nursing diagnoses had increased. Results of the research provide an overview of the importance of the training in improving the quality of nursing documentation and aid the educators in planning the trainings, focusing more on the challenges in the documentation.

THE EFFECT OF GROUP FOCUSED CASE STUDY ON NANDA-I NURSING DIAGNOSIS IDENTIFICATION AND PERCEPTION IN NURSING STUDENTS

Objective: To identify the impact of group case studies on the accurate nursing diagnosis of the students and their perception of NANDA International nursing diagnoses. Method: The sample comprised 164 nursing students from a Department of Nursing in a university. Data was collected with the descriptive characteristics form, Perception of Nursing Diagnoses Scale, students’ opinion about nursing diagnoses form and care plan assessment form. A researcher offered four hours of theoretical training about the nursing process and NANDA International nursing diagnoses. Training was conducted by a researcher after training, the students filled out descriptive characteristics form and the Perception of Nursing Diagnoses Scale. Thereafter, the students were randomly divided into five groups. Each group made two case studies with a researcher every week. After the completion of case studies, the students filled out the forms again. Results: It was determined that the majority (89.6%) of the students were able to make accurate NANDA International diagnoses after case studies. The total score of the students in perception of nursing diagnoses was not statistically significant (p>0.05). Statistically significant difference was obtained in the negative way in the clear representation of patient situation subscale and in the positive way in the ease of use subscale of the scale ( p<0.05). Conclusion: Almost of the students were able to determine the accurate NANDA International nursing diagnosis and it didn’t have an effect on the students' perception of nursing diagnoses, but the scale's ease of use subscale had a positive impact.

A Clinical Decision Support System as a Tool to Improve the Accuracy of Nursing Diagnoses

Introduction: Nursing diagnosis is an important part of the nursing process and it influences the quality of nursing care. Accuracy in establishing nursing diagnoses is one of the factors that determines the accuracy of the nursing intervention program and the speed of healing of the patients. The Clinical Decision Support System is an information system built to assist health workers in making clinical decisions including the enforcement of nursing diagnoses. Through this systematic review, the author wants to explain the clinical decision support system as a tool to increase the accuracy of the enforcement of nursing diagnoses.Methods: The search for journals using the PICOT framework was conducted in the Scopus, Proquest, PubMed and Cinahl databases with a 10-year publication time limit (2008 - 2018). There were 8 international journals reviewed in full.Results: Generally the journals reviewed stated that the use of the Clinical Decision Support System in establishing nursing diagnoses has been shown to improve the accuracy of nursing diagnoses.Conclusion: This systematic review concludes that the use of clinical decision support systems can help nurses or nursing students in establishing accurate nursing diagnoses.

Relationships between the Advanced Nursing Process quality and nurses' and patient' characteristics: A cross-sectional study.

AimThis study aimed to assess (a) nurses' knowledge and their attitude towards the Advanced Nursing Process—nursing assessment, diagnoses, interventions, outcomes, (b) the quality of the Advanced Nursing Process and (c) relationships with patient characteristics.DesignA cross‐sectional, descriptive correlational study was performed.MethodsNinety‐two registered nurses and ninety nursing records of six hospital wards were included. In January 2016, a knowledge test, a self‐assessment tool for measuring nurses' attitude (PND) and the Quality of Diagnoses, Interventions and Outcomes Revised instrument (Q‐DIO R) were applied. The correlations between nurses' knowledge, attitude, patient characteristics, organizational factors and the Advanced Nursing Process quality were investigated.ResultsNurses demonstrated low levels of knowledge, positive attitudes and an average Advanced Nursing Process quality. Accurate nursing diagnoses were strong and highly significantly related to effective nursing interventions and better nursing‐sensitive patient outcomes. A higher proportion of registered nurses was related to better nursing outcomes.

Relationship between Knowledge-Skill and Importance of Physical Examination for Children Admitted to Infectious Wards: Examining Nurses’ Points of View

Background: A careful, timely, and accurate examination of patients by nurses provides grounds for maintaining and improving patients' safety in hospitals. Proper examination of the health status of children and, consequently, an accurate nursing diagnosis can accelerate their recovery and can have positive effects on the family. Objectives: This study aimed to determine the relationship between knowledge-skill and the importance of physical examination of children admitted to infectious wards from the perspective of nurses working in Ilam hospitals in 2017. Methods: In this descriptive cross-sectional study, 150 nurses were selected using purposive sampling. To collect data, the demographic information questionnaire, physical examination knowledge-skill scale, and physical examination importance questionnaire were employed. Data were analyzed using the SPSS version 18. In addition, descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential tests (independent and paired sample t-tests) were used. Results: The findings revealed that the acquired knowledge-skill mean score was 100.86 out of 200. The nurses exhibited higher levels of knowledge-skill with regard to controlling vital signs, assessment of respiratory effort, observation of skin color, and touching the extremities to check the body temperature. In contrast, they exhibited lower levels of knowledge-skill in terms of examination of the breast to assess lumps, examination of the spine, assessing how the patient is talking, and listening to lung sounds. Additionally, there was a significant positive correlation between knowledge-skill and the importance of pediatric physical examinations (P < 0.05). Conclusions: Considering that the mean score of nurses in terms of the knowledge-skill required for conducting pediatric physical examination was low, appropriate interventions should be planned by nursing managers to improve the status of nurses' knowledge-skill in this field, in order to ensure the use of the necessary procedures for effective nursing practice. © 2018, Journal of Comprehensive Pediatrics.

Nursing diagnosis Chronic Pain from the patients’ perspective

Chronic pain is one of the priority problems in palliative care. The study objective was the validation of the nursing diagnosis of Chronic Pain (00133) in patients in palliative care. It is a retrospective study. To evaluate the defining characteristics of the nursing diagnosis, we used the patient-focused clinical diagnostic validity model of Fehring, which uses information obtained directly from patients. We designed a questionnaire-type measurement tool containing 15 defining characteristics of the nursing diagnosis of Chronic Pain (00133). The sample included n=83 patients in palliative care who were treated for pain for at least six months. The defining characteristics were rated by the patients on the Likert-type scale (from 1 – not at all characteristic of me, to 5 – very characteristic of me). After data collection, we calculated weighted scores (WS) for each of the defining characteristics. We used correlation analysis to analyze the relationships between the risk factors. None of the 15 defining characteristics were considered major by the patients. Seven defining characteristics were considered minor: pain (0.68), changes in sleep pattern (0.55), altered ability to continue previous activities (0.54), fatigue (0.52), atrophy of the involved muscle group (0.51), fear of re-injury (0.51), and restlessness (0.50). Eight defining characteristics were discarded by the patients. A statistically significant relationship was found between eight pairs of the minor defining characteristics, p<0.01. The study results suggest the essential defining characteristics that may help nurses in identifying and defining an accurate nursing diagnosis in clinical practice.

Nursing Assessment Tool for People With Liver Cirrhosis.

The aim of this study was to describe the process of developing a nursing assessment tool for hospitalized adult patients with liver cirrhosis. A descriptive study was carried out in three stages. First, we conducted a literature review to develop a data collection tool on the basis of the Conceptual Model of Wanda Horta. Second, the data collection tool was assessed through an expert panel. Third, we conducted the pilot testing in hospitalized patients. Most of the comments offered by the panel members were accepted to improve the tool. The final version was in the form of a questionnaire with open-closed questions. The panel members concluded that the tool was useful for accurate nursing diagnosis. Horta's Conceptual Model assisted with the development of this data collection tool to help nurses identify accurate nursing diagnosis in hospitalized patients with liver cirrhosis. We hope that the tool can be used by all nurses in clinical practice.

Chronic Pain: Content Validation of Nursing Diagnosis in Slovakia and the Czech Republic.

The main purpose of the study was to validate the defining characteristics and related factors of the nursing diagnosis "chronic pain" in Slovakia and the Czech Republic. This is a descriptive study. The validation process involved was based on Fehring's Diagnostic Content Validity Model. Three defining characteristics (reports pain, altered ability to continue previous activities, and depression) were classified as major by Slovak nurses, and one defining characteristic (reports pain) was classified as major by Czech nurses. The results of the study provide guidance in devising strategies of pain assessment and can aid in the formulation of accurate nursing diagnoses. The defining characteristic "reports pain" is important for arriving at the nursing diagnosis "chronic pain."

Evaluation of the nursing process and use of an electronic documentation in an acute hospital in Switzerland

Research questions The main purpose of this study was to evaluate the impact of the educational program Guided Clinical Reasoning (GCR) on the quality of nursing documentation in an acute hospital in Switzerland. Additionally the effect of the introduction of an intelligent electronic nursing documentation expert system (e-doc) and simultaneous cessation of GCR were examined in 2011. Methods To evaluate the impact of GCR a cross-sectional evaluation study was conducted at three measurement points in the years 2005, 2006 and 2011. Each sample of 36 documentations was rated by the instrument “Quality of Nursing Diagnoses, Interventions and Outcomes” (Q-DIO) and the results compared with a quantitative design. To study the effects of the e-doc a descriptive design was used. The amount of chosen nursing diagnoses and their degree of content accuracy was analyzed for both nurses and the electronic documentation system. Furthermore the level of correct “decision support” in hypothetical nursing diagnosis by the e-doc and the use of this offer by nurses were contrasted. Findings The GCR program showed the best effects regarding the quality of the nursing process in 2006. Despite implementing an intelligent e-doc system as decision support tool, measurement point three (2011) proved the lowest scores, except for phrasing accurate nursing diagnoses. The quality of documentation regressed to the level of 2005, one year after implementing nursing diagnostics. The skills for using the NNN (NANDA, NIC, NOC) nursing process accurately, acquired in 2006, did not sustain. While nurses wrote detailed reports, they used a limited amount of recurring diagnoses. In comparison e-doc consistently and abundantly provided correct hypothetical nursing diagnoses. Despite this support they were scantly used by nurses. Conclusions Being at close temporal proximity the first two measurement points provided constant training for nurses in GRC and a high documentation quality was achieved. To accurately depict the nursing process, an electronic support system alone did not suffice, particularly as the GCR program was terminated. Electronic support systems can assist in conducting a theory-based nursing process, but clinical reasoning is essential for a meaningful use of e-docs. Constant support of nurses and awareness of barriers in conducting the nursing process and using intelligent decision supporting tools are crucial for a high level of quality in nursing documentation.

Evaluation of the Accuracy of Nursing Diagnoses in a Brazilian Emergency Service

The study aims to verify the accuracy of 10 prevalent nursing diagnoses (NDs) in the emergency service of a Brazilian university hospital. The accuracy of 10 prevalent diagnoses was evaluated using the Lunney (1990) scale. The evaluation was based on data recorded from patient charts by nurses. Each diagnosis was evaluated in three separate clinical instances, resulting in a total of 30 evaluations. The evaluation characterized 24% (7) of the NDs as highly accurate, while 76% (23) were considered to be of low accuracy. The low levels of accuracy detected in some diagnoses highlight the need for nurses to develop skills in accurately applying the diagnostic process involving the use of NDs. However, in order to confirm (or not) the observed low levels of diagnostic accuracy, studies with larger sample sizes should be carried out. This is essential as it is recommended that care processes be supported by knowledge about accuracy. Educational interventions should be implemented that hone the ability to make accurate NDs in clinical nursing practice. Further studies are also needed to evaluate the accuracy of NDs elaborated by nurses in different clinical contexts.

Pediatric Trichotillomania: Clinical Presentation, Treatment, and Implications for Nursing Professionals

Trichotillomania (TTM), or compulsive hair pulling, is a disorder that typically onsets in childhood. It is mistaken to believe that children will "age out" of this behavior, as pediatric TTM often has a chronic, debilitating course that does not remit without treatment, resulting in considerable psychological and physical impairment. Because most children with TTM will be seen initially by nursing professionals in the practices of dermatologists, pediatricians, gastroenterologists, and other disciplines, raising nurses' awareness of this disorder is of the utmost importance for accurate nursing diagnosis and assessment. As the health care providers who spend the greatest amount of time with patients, nurses' detection and diagnosis of TTM can make a critical difference in the initiation of early intervention. Therefore, the purpose of this article is to provide an overview of pediatric TTM, including its epidemiology, clinical presentation, and treatment options, from the perspective of nurses who may interact with such patients in their workplace.

Implementing nursing diagnostics effectively: cluster randomized trial

This paper is a report of a study to investigate the effect of guided clinical reasoning. This method was chosen as a follow-up educational measure (refresher) after initial implementation of standardized language. Research has demonstrated nurses' need for education in diagnostic reasoning to state and document accurate nursing diagnoses, and to choose effective nursing interventions to attain favourable patient outcomes. In a cluster randomized controlled experimental study, nurses from three wards received guided clinical reasoning, an interactive learning method. Three wards, receiving classic case discussions, functioned as control group. Data were collected in 2004-2005. The quality of 225 randomly selected nursing records, containing 444 documented nursing diagnoses, corresponding interventions and outcomes was evaluated by applying 18 Likert-type items with a 0-4 scale of the instrument Quality of Nursing Diagnoses, Interventions and Outcomes. The effect of guided clinical reasoning was tested against classic case discussions using T-tests and mixed effects model analyses. The mean scores for nursing diagnoses, interventions and outcomes increased significantly in the intervention group. Guided clinical reasoning led to higher quality of nursing diagnosis documentation; to aetiology-specific interventions and to enhanced nursing-sensitive patient outcomes. In the control group, the quality was unchanged. Guided clinical reasoning supported nurses' abilities to state accurate nursing diagnoses, to select effective nursing interventions and to reach and document favourable patient outcomes. The results support the use of the North American Nursing Diagnosis Association, Nursing Interventions Classification and Nursing Outcomes Classification classifications and demonstrate implications for the electronic nursing documentation.

Klinische Entscheidungsfindung: Förderung des kritischen Denkens im pflegediagnostischen Prozess durch Fallbesprechungen

Case studies, based on actual patients' situations, provide a method of clinical decision making to foster critical thinking in nurses. This paper describes the method and process of group case studies applied in continuous education settings. This method bases on Balints' case supervision and was further developed and combined with the nursing diagnostic process. A case study contains different phases: Pre-phase, selection phase, case delineation and case work. The case provider narratively tells the situation of a patient. This allows the group to analyze and cluster signs and symptoms, to state nursing diagnoses and to derive nursing interventions. Results of the case study are validated by applying the theoretical background and critical appraisal of the case provider. Learning effects of the case studies were evaluated by means of qualitative questionnaires and analyzed according to Mayring. Findings revealed the following categories: a) Patients' problems are perceived in a patient centred way, accurate nursing diagnoses are stated and effective nursing interventions implemented. b) Professional nursing tasks are more purposefully perceived and named more precise. c) Professional nursing relationship, communication and respectful behaviour with patients were perceived in differentiated ways. The theoretical framework is described in the paper "Clinical decision making and critical thinking in the nursing diagnostic process". (Müller-Staub, 2006).

Recognizing Opportunities for Spiritual Enhancement in Young Adults

Purpose.To describe opportunities in the lives of young adults that strengthen or enhance spirituality. Methods. Descriptive, qualitative. Tape‐recorded, semi‐structured interviews were conducted with 13 well adults the ages 18 to 24. Interview transcripts, field notes, vignettes, and research committee minutes were analyzed to reduce coded data into conceptual categories and themes. Findings. Seven themes emerged from the participant's responses to probes: Beliefs, Connectedness, Inner Motivating Factors, Life Events, Divine Providence, Understanding the Mystery, and Walking Through. Conclusions. The accurate assessment of spiritual needs of young adults may be contingent on the assessment of their developmental needs. Knowing the opportunities that present in the lives of young adults to foster spiritual growth is important for nurses, who often are present when these opportunities occur. Practice Implications. Standardized language is limited for accurate nursing diagnosis of human responses in the spiritual domain. The findings support a new wellness nursing diagnosis, “Readiness for Enhanced Spirituality,” to conceptualize a spirituality continuum and support wellness diagnoses. Search Terms: Nursing diagnosis, psychosocial development, religiosity, spirituality, transitions stage

Assessing urge incontinence in elderly women

~ni e North American Nursing Diagnosis Associaon (NANDA) has identified five nursing diagoses related to alterations in urinary incontinence: stress, urge, functional, reflex, and overflow. ! Of these, urge incontinence has been identified as the most common of the established types of urinary incontinence found in the elderly. 2 If nurses are to diagnose types of urinary incontinence correctly, they must be able, with some degree of certainty, to differentiate urge incontinence from other incontinence types. Unless an accurate nursing diagnosis is made, effective nursing interventions cannot be designed or implemented. Therefore the purpose of this article is to report findings related to the signs and symptoms (defining characteristics) associated with the nursing diagnosis of urge incontinence in elderly women. When nurses use clinically valid signs and symptoms to assess elderly incontinent women, they will be able to make the diagnosis of urge incontinence more accurately and, consequently, prescribe and implement the interventions most likely to be effective in treating the urge incontinence symptoms.

Validation of defining characteristics: clinical design.

In order to formulate accurate nursing diagnoses, neuroscience nurses must determine clinical validity of defining characteristics. Physiologic, psychologic, behavioral or social signs and symptoms may be studied. This article suggests methods to be used in validating defining characteristics including practical and research design considerations.

Teaching nursing diagnoses to school nurses: a standardized measure of the cognitive effect.

ABSTRACT A continuing education program on nursing diagnosis was conducted for school health nurses. A formal evaluation procedure was performed to measure the programs effectiveness in cognitive and behavioral terms. This article describes the process to measure the cognitive impact. Twenty-one school nurses volunteered to participate and were randomly assigned to the experimental group (N = 10) or the control group (N = 11). Five school health or nursing diagnosis experts created and reviewed two case studies in a two-round review for consensus and to validate a rating standard. Nurses in the experimental group read and assigned nursing diagnoses to a case study, before and after participating in the five-week program. Accurate nursing diagnoses reported for the case study increased with statistical significance from pre to post test. While behavior, or use of nursing diagnoses in clinical practice, was the ultimate goal, assurance of the ability to accurately assign nursing diagnoses was an essential intermediate step. The simulated case study, with an expert panel to formulate an objective rating standard, provided a feasible and effective method to measure accurate identification of nursing diagnoses, the cognitive domain.