Nursing Assessment Tool Research Articles

Diagnostic accuracy of two pressure ulcer risk scales and a generic nursing assessment tool. A psychometric comparison

Comparison of the diagnostic accuracy of two pressure ulcer risk assessment scales and one generic nursing assessment tool. Guidelines for pressure ulcer prevention recommend an initial risk screening of all patients, followed by appropriate nursing interventions. Additionally, personal and financial resources have to be allocated carefully to avoid excessive or too little treatment. Risk assessments should be accurate and applicable, and some studies showed that generic nursing tools also provide specific information for nursing diagnoses, like risk for pressure ulcer. Cross sectional observational study. A total of 1053 adult patients of a university hospital in Germany were investigated. For each patient, the Braden Scale, the Waterlow Scale and the Care Dependency Scale were completed. A skin inspection was conducted by trained nurses. Correlations between the three scales and the mean values of each pressure ulcer risk assessment scales for each Care Dependency Scale value were calculated. To determine the association between susceptibility to pressure ulcer and observed pressure ulcer, the area under the curve was calculated. There was a higher correlation between the Braden Scale and the Care Dependency Scale (r = 0.82) than between the two pressure ulcer risk assessment scales (-0.65). The highest area under the curve was reached by the Braden Scale (0.86), followed by the Care Dependency Scale (0.83) and the Waterlow Scale (0.81). Only the Braden Scale (cut-off 18) and the Care Dependency Scale (cut-off 65) reached the psychometric requirements of at least 70% sensitivity and 70% specificity. The Care Dependency Scale could be used for both a general nursing assessment and as a screening tool for risk for pressure ulcers. The Braden Scale showed the highest association with the occurrence of pressure ulcer. The Care Dependency Scale is a useful screening tool to identify patients at risk for pressure ulcers. Nursing assessment activities might be reduced by using a generic nursing assessment tool also for specific risk screening.

A New Public Health Nursing Assessment Tool

Background: The authors designed a new Public Health Nursing Assessment Tool (PHNAT) that combines Healthy People 2010 determinants of health (biology, behavior, social environment, policy and interventions, and access to care), health status, the Minnesota Department of Health Population-Based Public Health Nursing Practice Intervention Wheel Strategies, and self-reflection.Purpose: The purpose of this study was to pilot the use of the PHNAT with nursing students and an expert in public health nursing.Methodology: A pilot group consisting of 4 RN-BS students in their public health nursing clinical experience completed the PHNAT and critiqued its usability and relevance pertaining to their public health course and population based assessment. An expert in the field of public health nursing also reviewed the PHNAT for face validity. A critique of the reviewers was assessed by the authors of the tool and changes made accordingly.Findings: Participants found the PHNAT enabled them to more readily use the determinants of health as a guide in assessing the population and community and directed them to apply the Intervention Wheel Strategies. The comprehensiveness of the PHNAT also suggested that the completion of a public health nursing assessment would lend itself to group work in a course or in the practice setting. Some sections needed revision as did the instruction guide.Summary Concluding Statement: The unique qualities of the PHNAT provide the public health nurse with data to analyze and ultimately determine the priority health care issues for a specific population within a community. It has potential to be used in the baccalaureate and possibly graduate nursing programs as well as in public health settings. Further studies need to be carried out on the efficacy of the tool and its use in supporting the health of the individual, family, population, and community. Background: The authors designed a new Public Health Nursing Assessment Tool (PHNAT) that combines Healthy People 2010 determinants of health (biology, behavior, social environment, policy and interventions, and access to care), health status, the Minnesota Department of Health Population-Based Public Health Nursing Practice Intervention Wheel Strategies, and self-reflection. Purpose: The purpose of this study was to pilot the use of the PHNAT with nursing students and an expert in public health nursing. Methodology: A pilot group consisting of 4 RN-BS students in their public health nursing clinical experience completed the PHNAT and critiqued its usability and relevance pertaining to their public health course and population based assessment. An expert in the field of public health nursing also reviewed the PHNAT for face validity. A critique of the reviewers was assessed by the authors of the tool and changes made accordingly. Findings: Participants found the PHNAT enabled them to more readily use the determinants of health as a guide in assessing the population and community and directed them to apply the Intervention Wheel Strategies. The comprehensiveness of the PHNAT also suggested that the completion of a public health nursing assessment would lend itself to group work in a course or in the practice setting. Some sections needed revision as did the instruction guide. Summary Concluding Statement: The unique qualities of the PHNAT provide the public health nurse with data to analyze and ultimately determine the priority health care issues for a specific population within a community. It has potential to be used in the baccalaureate and possibly graduate nursing programs as well as in public health settings. Further studies need to be carried out on the efficacy of the tool and its use in supporting the health of the individual, family, population, and community.

Using NDNQI data to manage CAUTI

ospital-acquired catheter-associated uri-nary tract infections (CAUTIs) are clas-sified as a never event by the Centersfor Medicare and Medicaid Services(CMS) and are no longer reimbursed.Never events can cause serious injuryor death to patients and result in increasedcosts from additional days in the hospital,nursing care, medical treatments, and devices.Therefore, the new rule puts forth an incentivefor hospitals to eliminate or reduce neverevents in order to avoid costs for which therewill be no reimbursement. To prepare for thisresponsibility, nurse managers must knowmore about the prevalence of never events,improve nursing assessment tools and preven-tion strategies, and identify best practices foreffective and efficient treatment of theseevents. By implementing effective practices ina sustainable manner and monitoring theimpact of those interventions, nurse managerscan reduce avoidable, nonreimbursed costs totheir facilities.The National Database of Nursing QualityIndicators (NDNQI) began collecting data onCAUTI rates for ICUs in the fourth quarter of2007. Using these data, nurse managers cancompare the CAUTI rates for their units withpeer units in similar facilities and examinetrends in their rates over time.Defining CAUTICAUTIs may be the least regarded never eventbecause they’re viewed as a minor infectioncausing less morbidity and mortality than cen-tral line-associated bloodstream infections, forexample.

Pressure ulcer risk screening in hospitals and nursing homes with a general nursing assessment tool: evaluation of the care dependency scale

In view of an increasing necessity for systematic assessments, nursing practice would benefit from a simplification of assessment procedures. These assessments should be scientifically based. To evaluate the possibility of assessing pressure ulcer risk as well as care dependency simultaneously with a standardized instrument for nursing homes and hospitals. Care dependency was measured with the Care Dependency Scale (CDS). The quantitative analyses were accomplished with data from a cross-sectional study that was performed in 2005 in 39 German nursing homes and 37 hospitals with a total of more than 10,000 participants. The scale's construct validity was calculated with Pearson's r, and predictive validity was evaluated by computing sensitivity and specificity values and the area under the curve (AUC). Item-level analyses included calculations of odds ratios, relative risks and logistic regression analyses. Construct validity of the CDS was r = 0.79 (P < 0.01) in nursing homes and r = 0.89 (P < 0.01) in hospitals. AUC was 0.80 in hospitals and 0.65 in nursing homes. Analyses on item level identified 'mobility' as a key item in both settings and additional differing key items for nursing homes and hospitals. The CDS is a well-functioning tool for pressure ulcer risk detection in hospitals. For this purpose, the most appropriate cut-off point is 69 while special regard is given to the items 'continence', 'mobility' and 'hygiene'. In nursing homes the usefulness of the CDS for pressure ulcer risk detection is limited. Here, the most appropriate cut-off point is 41 and attention is given to the items 'mobility', 'getting (un)dressed', 'hygiene' and 'avoidance of danger'.

Preoperative Nursing Assessment of the Surgical Patient

Thorough assessment of the surgical patient begins in the preoperative phase and extends throughout the perioperative experience. Patient-centered interviews gather critical data that contribute to a successful experience and a focused plan of care. Information collected, documented, and conveyed to the surgeon or physician assists in appropriate medical decision making. This article focuses on perioperative nursing assessment tools and discusses issues pertinent to achieving safe delivery of care. A broad overview touches on key topics that deserve exploration and evaluation. This article will hopefully serve as a useful tool that helps direct the decision-making process.

Ett nivaspecifikt bedomningsinstrument for sjukskoterskeprogrammets kliniska utbildning

The aim of this study was to develop an assessment tool for clinical nursing education specific for the three levels of undergraduate nursing education. The purposed context for the assessment tool was Swedish university baccalaureate nursing programs. The assessment tool was developed, tested and evaluated stepwise. First, a theoretical frame concerning knowledge and competence in nursing was developed assuming continuity between theoretical and practical knowledge out of complex competences. Then, objectives for learning in terms of competences were operationalized. The Sahlgrenska University Clinical Nursing Assessment Tool (SUCNAT) for the three levels of nursing education is structured into three areas of competences: practical skills, problem solving and reflection, and professional stance. It is aimed for student self evaluation in combination with nurse evaluation of student's competence as basis for evaluation of students in clinical education. In addition, a questionnaire to students, their supe...

Relationship between quality of care, staffing levels, skill mix and nurse autonomy: literature review

This paper reports a literature review exploring the relationship between quality of care and selected organizational variables through a consideration of what is meant by perceptions of quality, whose perceptions are accorded prominence, and whether changes in staffing, skill mix and autonomy affect perceptions of quality. Three basic ideas underpin this literature review: the growing focus on quality improvement in health care, concerns about the quality of care, and the move towards patient involvement and consultation. Of particular interest is the way in which changes in nurse staffing, skill mix and autonomy may affect the delivery of quality patient care. A search was conducted using the CINAHL, Medline and Embase databases. Key words used were quality of health care; quality of nursing care; nurse; patient; skill mix; nurse-patient ratio; outcomes; adverse health care events and autonomy. The objective was to draw together a diverse collection of literature related to the field of health care quality. Papers were included for their relevance to the field of enquiry. The original search was conducted in 2003 and updated in 2004. Quality of care is a complex, multi-dimensional concept which presents researchers with a challenge when attempting to evaluate it. Traditional nursing assessment tools have fallen out of use, partly because they have failed to provide opportunities to engage with and access the views of patients or nurses. There is also evidence that patient satisfaction as an indicator of quality is compromised on a number of fronts. There is conflicting information on how nurses and patients think about quality. Research looking at the relationship between the selected organizational variables and perceptions of quality also suffers from a number of limitations. We argue that there is a requirement for more patient-centred research exploring perceptions of quality and differences in nurse staffing, skill mix and autonomy.

Factors Related to Stress in Outpatients with Permanent Colostomies

The main purpose of this study was to explore factors related to stress in outpatients with permanent colostomies, using a convenience sample. Subjects were selected from one medical center in southern Taiwan. The Stress of Colostomy Patients Scale and demographic data were collected using questionnaires either at the colorectal outpatient department or in the home of colostomy patients. Seventy-three subjects with colostomies participated in the study. Other diseases and caregivers of colostomy patients influenced overall stress in outpatients with permanent colostomies. The five major stressors were: "I have urination problems"; "I feel tired easily owing to physical decline"; "I can't travel freely because of my colostomy"; "I worry about recurrence of the disease"; and, "I suffer from insomnia". This study provides important information for assessing the stress level of outpatients with permanent colostomies and for developing nursing assessment tools for colostomy patients. To alleviate the overall stress of colostomy patients and to help them return to the activities of daily living before the operation, health care professionals could design individual nursing care plans based on data from assessment tools.

Continence assessment in primary care: what is the next step?

There are many assessment 'forms' available for the collection of information in relation to bladder dysfunction. In many cases such forms have not been fully validated and should only be considered on a face validity basis. Validated symptom scores are available but these are generally used within specific areas of urology, e.g. lower urinary tract symptom scores for prostate screening. This article explores the need for an improved validated assessment and symptom scoring tool for nurses within primary care, to enable nurses to establish a preliminary diagnosis in adult patients presenting with bladder symptoms.

A nursing assessment tool for adults with fecal incontinence

Fecal incontinence affects slightly more than 1% of community-dwelling adults. This article describes an assessment format, with a research basis when available, that has been developed in a specialist nursing clinic in the United Kingdom. The focus is on how to obtain the most useful information from the patient to plan appropriate nursing interventions. A subsequent article will describe the biofeedback program developed as part of a package of care to meet individual needs of persons with fecal incontinence. (J WOCN 2000;27:279-91).

A Nursing Assessment Tool for Adults With Fecal Incontinence

A Nursing Assessment Tool for Adults With Fecal Incontinence

Development of an alarm system for the prevention of falls in hospitalized patients

The present study describes the analysis of an online patient assessment system developed to prevent inpatients falls. A chart review was performed in order to identify risk factors present in the Nursing Assessment tool. The identified variables were Functional status including walking, transferring and toilet, sex and patients self-care ability. Authors developed a system using these variables, that is available since February 1997. In a second phase of this study, authors aim to evaluate the effectiveness of this computerized intervention.

The management of nausea and vomiting in advanced cancer.

Nausea and vomiting represent a significant problem in patients with advanced cancer, which not only affects their quality of life but also the lives of informal carers. The application of nursing assessment tools, underpinned by a thorough knowledge regarding the physiology and aetiology of nausea and vomiting in this group of patients enables nurses to plan and provide effective interventions, in collaboration with other members of the multidisciplinary team. This article describes the physiological basis of nausea and vomiting. Epidemiological data informs the subsequent discussion, which focuses on assessment in terms of identifying the problem and its cause(s), setting goals with the patient and his/her carers, planning appropriate nursing intervention to support medical interventions and evaluating clinical outcomes. Pharmacological and non-pharmacological interventions for nausea and vomiting are discussed.

A Study of Tool Development on Psychiatric Nursing Assessment Based on Roy’s Adaptation Model

It is important for psychiatric nurses to understand client*s behavior thus developing effective relationships between clients and nurses. This study was conducted to designing an assessment tool, which is helpful to nurses in the psychiatric mental-health setting. This tool, based on Roy’adaptation model, is adopted the various nursing setting and validates the applicability. The research was doing from Dec. 1995 to Jan. 1997. During the first stage, this tool was designed through literature re view and nursing history form, using one national psychiatric hospital, five university affiliated hospital, and a neuropsychiatric ward. Secondly, the tool was distributed to psychiatric nurses, who were asked to fill out the form and write the strength and weakness after having been interviewed. The last stage, incorporated a case study using this tool. The evaluation of this tool helped the researcher gather much of data required to make a specific nursing diagnosis, Finally, a psychiatric nursing assessment tool was designed to identify the four adaptation levels. The positive responses included the ability of the nurses to ask specific questions and guide the direction of interview, systematically by four adaptive modes. A number of nurses stated in the evaluation meeting that this tool helped them to get to know the patients more fully and to broaden their perspective in nursing assessment. The negative responses were : the tool was too long to provide an effective interview and was not clear regarding the boundaries of the three modes : self-care, interdependence, and role function modes.Consequently, the redundant items was partially excluded. The check list form was included in physiological mode for time and anti-psychotic drug’side effects which caused severe trouble in therapeutic setting was added in physiological mode neurological. The self-concept mode items including mental status examinations, have a high relevance with mental health assessment. Finally, further study is needed to increase the effectiveness and adequacy of this tool.

A psychiatric nursing admission assessment tool for children and adolescents.

To ensure that children and adolescents receive quality care, psychiatric nurses must gather assessment data on admission that is accurate and comprehensive. This step of the nursing process is becoming more crucial as hospital stays decrease, requiring nurses to prioritize patient needs quickly and implement plans of care. The authors describe the development of a nursing admission assessment tool designed to collect data systematically on children and adolescents admitted to acute inpatient psychiatric units. Lewin's change theory (1961) is used as a framework for describing the challenges of instituting a new documentation system.

Theory to practice: developing a Rogerian‐based assessment tool

Nursing models are invaluable in the direction they provide for nursing practice, education and research. The growth and development of the nursing profession is enhanced when its practice is guided by nursing theory. Rogers' Science of Unitary Human Beings is appealing to nursing because of its open-systems perspective and focus on holistic and individualistic care. Rogers' model is utilized to develop a nursing assessment tool that may be used in a variety of situations. The Rogerian-based assessment tool is used to gather data from a postpartum mother experiencing the challenges of her first newborn. Problems incurred while developing and utilizing the tool are discussed. Rogers' model is shown to be practical and effective in this case study.

Systematic pain records and their impact on pain control

This study examined the impact of a systematic nursing pain assessment tool (PAT) and pain flow sheet (PFS) on pain management. A control group (N = 23) was compared with a treatment group (N = 20) of hospitalized patients on a medical oncology unit. In the control group, "routine" charting of pain was done in the nurses' narrative notes. Patients in the treatment group underwent standardized pain assessment and documentation using a PAT and PFS. The treatment group reported significantly lower average pain intensity ratings (chi 2 = 5.019, p = 0.02) on day three of follow-up. In addition, a greater number of patients in the treatment group (85%) reported decreased pain intensity from day one to day three as compared with the control group (57%). This study supports other research and recommendations in the literature that use of systematic pain records can improve pain management.

Biopsychosocial Nursing Assessment: A Way to Enhance Care Plans

1. A psychiatric nursing assessment tool reinforces the primary nursing care model; re-establishes nursing's input at comprehensive treatment plan meeting; reorients the staff to the total nursing needs of the client; and provides a tool for establishing nursing diagnoses. 2. Implementation of the nursing assessment form has educated other staff about professional nursing practice, as well as promoted a greater understanding of the nursing process and reinforced accountability for the nurses. 3. The form enables clients to be viewed from a holistic biopsychosocial nursing context, and nursing care plan recommendations are more individualized and inclusive of the total aspects of patient needs.

The root of it all--genograms as a nursing assessment tool.

1. The genogram is a tool that can be used by nurses to provide a comprehensive, holistic picture of the elderly client and his environment. A genogram can serve both as an assessment tool and as an intervention strategy. 2. Information gathered through a genogram can be classified as demographic, functional status/resources, and critical events/dynamic changes. 3. The ability of the elderly client to actively participate in the genogram process gives assessment data about the client's functioning in sensoriperception, memory, functional communication, fine motor skills, and behavioral domains. 4. The genogram provides a highly organized and easily visualized method of gathering, displaying, and communicating information to the elderly client and to other health-care professionals.

Assessment tool for nurses' learning needs and priorities relative to caring for patients with AIDS and Kaposi's sarcoma.

Up to 25% of people living with HIV (PLWHA) in South Africa are thought to suffer from some form of depression and anxiety during the course of the illness. The nurse-initiated ART improves patients’ access to ART and gives nurses authority to treat uncomplicated patients. However, there is no parallel continuing development program aimed at preparing nurses to manage mental health problems at primary health care level. The purpose of the study was to explore nurses’ interpretation and implementation of HIV/AIDS guidelines for mental health screening among HIV-infected individuals in South Africa.A qualitative, exploratory and descriptive approach was employed, using purposive sampling to select primary health professional nurses trained in HIV programmes at five primary health care facilities. Data were collected through focus groups and in-depth individual interviews. Thematic analysis was used to generate three themes, namely; guidelines as framework for care pathway, mental screening practices, strengthening mental health screening. The study revealed significant weakness in the detection of mental illness in primary health care settings, due to a lack of skills and insufficient screening resources. The implication of these findings is a need to equip all NIMART trained nurses with basic mental health screening skills.