Nursing Diagnosis Research Articles

Nursing Interventions Related to the Need for Oxygenation in Severe COVID-19 Disease in Hospitalized Adults: A Retrospective Study.

To describe the nursing interventions related to the need for oxygenation in hospitalized adults with severe COVID-19 disease in the Intensive Care Unit. This was an observational, retrospective and descriptive study in a population of 2205 patients with a convenience sample of n = 430 and based on the North American Nursing Diagnosis Association (NANDA), the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). The analysis was performed with a non-parametric test to determine the association between the nursing interventions and the need for oxygenation. The findings are aimed at improving nursing interventions with statistical associations as follow: oxygen therapy (p < 0.000), airway suctioning (p < 0.000), airway management (p = 0.029), invasive mechanical ventilation (p < 0.000) and non-invasive mechanical ventilation (p = 0.022). NOC taxonomy expected outcomes in ventilation, 34% (146), alteration in gas exchange, 33.7% (145), and respiratory status, 558.9% (253), were severely compromised. The nursing interventions to maintain the respiratory status are focused on airway care and oxygen therapy in order to increase the oxygen saturation level and decrease the severity of the need for oxygenation.

Exploring the Impact of Medical Complexity on Nursing Complexity of Care in Paediatric Patients: A Retrospective Observational Study.

To explore the impact of medical complexity, defined by the number of chronic conditions, on the complexity of care, as described by the frequency of nursing diagnoses (NDs) and nursing actions (NAs), in paediatric patients. Retrospective observational study. This study was conducted in an Italian university hospital and involved the analysis of electronic health records for neonatal and paediatric patients who were consecutively admitted from January to December 2022. The sample was classified into three categories-non-chronic, single chronic and multimorbid patients-according to their clinical profiles. NDs recorded within the first 24 h from patient hospital admission and NAs performed throughout the hospital stay were counted for each group. Distinct variations in the prevalence and patterns of NDs and NAs were observed across different levels of medical complexity. A significant moderate positive correlation between the number of NDs and NAs was found. However, the frequency of NDs did not directly correlate with the number of chronic conditions. Conversely, a weak but significant negative correlation was identified between the quantity of NAs and the number of chronic conditions. While the frequency of NDs showed a stable but decreasing trend as the number of chronic conditions increased, a higher number of chronic conditions were associated with a lower quantity of NAs. We discovered a notable variation in the complexity of care across varying levels of medical complexity in paediatric patients. Our findings suggest that the complexity of care does not necessarily correspond to the degree of medical complexity. The observed negative relationship between the number of chronic conditions and the quantity of NAs underscores the need for further research to explore this unexpected finding and its implications for clinical practice. Without the adoption of standardised nursing terminologies, such as nursing diagnoses (NDs) and nursing actions (NAs), assessing the complexity of care in paediatric settings can be challenging. Integrating clinical nursing information systems that incorporate standardised NDs and NAs into electronic health records is crucial for accurately documenting and analysing the complexity of care and its relationship with medical complexity. In paediatric patients, the frequency of nursing diagnoses (NDs) at hospital admission is significantly associated with the quantity of nursing actions (NAs) delivered during hospitalisation. However, there is no correlation between the frequency of NDs and medical complexity, as defined by the number of chronic disorders. Specifically, the frequency of NDs decreases with increasing medical complexity, while the quantity of NAs is negatively associated with the number of chronic disorders. This indicates that the complexity of care cannot be inferred solely from medical complexity, and additional factors need to be explored. These findings enhance understanding of how complexity of care relates to medical complexity in paediatric patients. Insights into the prevalence and patterns of NDs and NAs can benefit nurses, managers, researchers and policymakers by informing clinical and organisational decision-making to ensure high-quality care. The study adhered to the RECORD Statement. Patients, service users, caregivers or public members were not directly involved in the design, conduct, analysis and interpretation of data or in writing this paper. Patients contributed only to data collection.

Content validation of the NANDA‐I nursing diagnosis risk for perioperative hypothermia (00254)

AbstractPurposeThe objectives of this study were to refine and validate the NANDA‐I nursing diagnosis risk for perioperative hypothermia (RPH) (00254).MethodsA quantitative, descriptive study was carried out according to the adapted diagnostic content validation model by Fehring. Data from a previously conducted literature study were triangulated with expert validation data to examine the nursing diagnosis RPH as well as potentially suggested new factors resulted from the literature review. In addition, the Wisdom of Crowds model was also considered. A nonprobability sampling technique, including purposive and snowball sampling methods, was used to recruit a panel of nurse experts. An anonymous and standardized questionnaire was developed in three languages for data collection. For validation, descriptive statistics, weighted ratios, and a one‐sample T‐test were used.ResultsNinety‐two nurse experts from seven countries and three continents participated in this study. Fifty‐eight nurse experts (63%) were female, and 33 (36%) were male, with a mean age of 42.26 years and 19.22 years of working experience. The diagnosis label, definition, 4 out of 5 risk factors (RF), 6 out of 14 at‐risk populations (ARPs), and 5 out of 9 associated conditions (ACs) were classified as major. One RF, eight ARP, and four ACs were considered minor. In addition, the experts validated 1 RF, 5 ARP, and 12 ACs from a previous literature study at least minor.ConclusionsThe nursing diagnosis RPH (00254) could be confirmed by specialized experts. No RF, ARP, or AC of the current nursing diagnosis needed to be rejected, and the added diagnostic indicators increased the robustness of the diagnosis.Implications for nursing practiceA precise concept of the nursing diagnosis RPH improves nurses' clinical reasoning and strengthens an individualized, evidence‐based care plan.

Functioning in an Illness and Quality of Life versus the Prevalence of Depression and Anxiety Disorders in Patients with High Cardiovascular Risk.

A chronic disease occurring in a person's life is a stressor, disrupting every aspect of their life. This study aims to assess the relationship between functioning in chronic illness and quality of life with the prevalence of symptoms of depression and anxiety in patients with high cardiovascular risk. This study included 200 patients (aged 18-80 years) under the care of a primary care physician, diagnosed with hypertension and/or hypercholesterolemia, and/or diabetes between 6 and 24 months before the enrollment. The presented analysis assessed the symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); and the quality of life of patients with cardiovascular disease using the Heart Quality of Life (HeartQoL) questionnaire and functioning in chronic illness using the Functioning in Chronic Illness Scale (FCIS). The HADS scores amounted to 4.34 ± 3.414 points for the HADS-Anxiety subscale and 3.20 ± 2.979 points for the HADS-Depression subscale. The score indicative of functioning in chronic illness assessed with the FCIS was 98.32 ± 13.89 points. The independent predictors of HADS-anxiety were HeartQoL Emotional and FCIS Global, while HeartQoL Global and FCIS Global were the independent predictors for HADS-depression. Better functioning in chronic illness (FCIS Global) was associated with less frequent symptoms of anxiety and depression based on the HADS: HADS-Anxiety (R Spearmann = -0.3969; p < 0.0001) and HADS-Depression (R Spearmann = -0.5884; p < 0.0001). Higher HeartQoL scores, both globally, as well as in emotional and physical dimensions, were associated with a lower severity of anxiety and depression assessed with the HADS: HADS-Anxiety (R Spearmann = -0.2909; p = 0.0001) and HADS-Depression (R Spearmann = -0.2583; p = 0.0002). The quality of life and functioning in chronic illness are connected with symptoms of depression and anxiety. When assessing the severity of the depression symptoms in relation to the individual aspects of functioning in chronic illness, the areas requiring supportive-educational intervention can be identified. The assessment of both functioning in a chronic disease and the severity of the depression symptoms should be included in a standard nursing diagnosis and further supportive and educational intervention.

Content validation of the nursing diagnosis "Insufficient breast milk production (00216)".

To review and validate the elements of the nursing diagnosis (ND) "Insufficient breast milk production" (00216) based on the literature and expert consensus, and to construct operational definitions (ODs) for its defining characteristics (DCs). It is a methodological study carried out in two phases. In the first phase, a scoping review was conducted, and in the second, a committee of experts reviewed the elements' content. Items with a Content Validity Index ≥0.8 were validated for relevance, clarity, and precision. Discussions were conducted until a consensus was reached on all items and criteria evaluated. The Ethics Committee approved the study. The final scoping review sample consisted of 61 articles, and 19 experts evaluated the content of the ND. All DCs were revised. Three at-risk populations, three associated conditions, and one related factor were added. Three elements had their category changed, and an element was deleted. Experts also validated ODs developed for all DCs. "Insufficient breast milk production (00216)" was validated by experts. This study improved the ND through literature and expert consensus. New elements were added, and existing ones were revised. This study improves this ND based on scientific evidence and clinical expertise and potentially improves nurses' diagnostic accuracy through ODs.

Clinical Validation of the Nursing Diagnosis 'Inadequate Health Self-Efficacy' in People With Hypertension.

To test the clinical validity of clinical indicators and causal relationships of aetiological factors of the new nursing diagnosis of inadequate health self-efficacy in people with hypertension. The diagnosis of inadequate health self-efficacy has both theoretical and content validity. However, a clinical validation study is needed to establish an appropriate framework for distinguishing individuals who manifest this unique human response. The study adopts a cross-sectional clinical validation approach, adhering strictly to the STROBE guidelines throughout its design and implementation. Naturalistic sampling was used to identify 302 adults diagnosed with hypertension. Their data were subjected to latent class analysis, which facilitated the identification of a comprehensive set of clinical indicators that demonstrated better diagnostic accuracy and established posterior probabilities to guide the inference of inadequate health self-efficacy. In addition, logistic regression analysis was used to assess the magnitude of the impact of aetiological factors. The prevalence of inadequate health self-efficacy was 76.61%. Among the 13 indicators examined, seven demonstrated notable sensitivity: 'risk-prone health behaviour', 'failure to take action that prevents health problems', 'inadequate self-control', 'avoidance behaviours', 'negative health self-perception', 'inadequate health-related quality of life' and 'difficulty feeling good about adopting a healthy lifestyle'. Additionally, two indicators showed high specificity: 'difficulty feeling good about adopting a healthy lifestyle' and 'inadequate adherence to treatment regimen'. Notably, 15 aetiological factors were identified as significantly associated with an increased risk of inadequate health self-efficacy. A clinical framework consisting of eight clinical indicators and 15 aetiological factors was developed to characterise inadequate health self-efficacy in individuals with hypertension. Clinical validation provides insight into the precision of clinical indicators and the magnitude of the effect of putative causal elements, thereby facilitating identification and tailored intervention for individuals with hypertension and inadequate health self-efficacy.

A study of attention allocation mode in clinical decision-making in nurses with different professional titles: an eye tracking experiment

Abstract Background: Attention is an important cognitive process. Cognitive and thinking processes can be explored by examining how attention is allocated and the characteristics of visual behavior. Clinical decision-making skills are the focus of nurses’ knowledge and competency development, and the application of attention allocation modalities and visual behavioral traits in the study of clinical decision-making is lacking. Objective: The aim of this experiment was to investigate the way in which attention is allocated in the clinical decision-making process of nurses of different professional rank and titles and associated factors. Methods: Seventy-six subjects from emergency departments of three hospitals in Beijing were recruited in this experiment using the convenience sampling method, including 28 junior nurses, 24 senior nurses, and 24 supervisor nurses. Subjects were required to complete clinical decisions tasks, and datas on subjects’ visual behavior were recorded and analyzed using a Tobii Pro eye-tracker during the decision-making process. Results: Nurses with high professional titles had a higher correct response rate in the nursing diagnosis and ranking of nursing diagnoses part (P&lt;0.05), and it was found that nurses with high professional titles would pay attention to pathophysiological mechanisms of illness earlier when making decisions (F=3.808, P=0.024).The heat maps showed differences in the attention allocation modes of nurses with different titles during the decision-making process. Conclusions: Lower-titled nurses focused more on the symptoms and signs section when making clinical decisions and paid less attention to the auxiliary examination results section, demonstrating a poorer level of active attention. Nurses with higher titles were relatively more comprehensive in their distribution of attention to patient disease information when making decisions and paid attention to the information in the patient’s auxiliary examination section earlier.

Nursing Care of the Patient Diagnosed with Multiple Myeloma as a Result of Trauma-Induced Fracture Development: A Case Report

Multiple myeloma is a neoplasm of plasma cells. Observed usually in patients over 65 years of age. This case report 41 year old has been prepared in order to determine the nursing diagnoses grouped according to the "Functional Health Patterns" model and to evaluate them in the nursing care plan of a patient who was diagnosed with multiple myeloma as a result of the examination which is that were noticed during a different examination. In the case for the problems; diagnoses of acute pain, sleep disturbance, undernutrition, deterioration of oral mucous membrane, constipation, fatigue, activity intolerance, risk of deterioration in individual identity, risk of deterioration in individual resistance, and nursing interventions for these diagnoses were planned and implemented. Before the study, verbal and written consent was obtained from the patient, and the data were collected by face-to-face interview method. As a result; the patient care process, which was planned and applied in line with the functional health patterns model, provided a positive improvement in the patient's behaviors that would negatively affect the disease process such as facilitated discharge, and guided nurses about care, effectiveness and follow-up of treatment. This model is recommended for the effective implementation of nursing care in clinics such as hematology, oncology, palliative care, where patients need to be followed actively.

Use of Silver Dressing on Diabetic Ulcers During Infection: Case Report

Aims: This study aimed to describe the results of applying silver dressing on diabetic ulcers during infection in patients with infected wounds on digiti one pedis dextra. Methods: This research uses a descriptive design, namely a case study with a nursing approach consisting of assessment, analysis of problem formulation, formulation of nursing diagnosis, intervention, implementation, evaluation, and nursing documentation. The subject of this case study is Mrs. A with diabetic ulcers on Digi 1 pedis extra with infection. Case management was carried out for three days on April 17-19, 2024. Data was collected through anamnesis, wound assessment, supporting examination, and literature study. Wound assessment was performed using the Meggitt-Wagner instrument for assessing wound severity and the SINBAD (Site, Ischemia, Neuropathy, Bacterial infection, Area ulcer, and Depth) system for improving foot ulcer management according to their severity and predicting major adverse foot events. Results: After three days of treatment using silver dressing, the wound condition shows that the infection has been resolved, and the wound has improved significantly from a grade 2 diabetic ulcer with abscess using the Meggitt-Wagner instrument and a SINBAD score of 3 (less severe ulcer) to a grade 2 diabetic ulcer without abscess and a SINBAD score of 2 (less severe ulcer). Conclusion: Wound care using silver dressing significantly accelerates the resolution of infections and supports the overall healing process

Nursing diagnoses related to cardiovascular function in primary care: A scoping review: Diagnósticos de enfermagem relacionados a função cardiovascular na atenção primária: Scoping review.

To map nursing diagnoses related to cardiovascular function reported in studies involving patients in primary care. A scoping review follows JBI guidelines. Literature searches were conducted from March to May 2024. Studies included focused on nursing diagnoses for adults and older adult patients with cardiovascular conditions in primary care settings. Results were systematically presented in tables and narratively. Among the 12 included studies, the most prevalent diagnosis was "noncompliance" (00079), removed from NANDA-I in 2017. Sixteen other diagnoses were identified, indicating a broader clinical profile of individuals with cardiovascular health issues in primary care. Most studies involved patients with hypertension in Brazil. Key nursing diagnoses for patients with cardiovascular conditions in primary care were identified. Ineffective health management emerged as a common characteristic among this population. Identifying prevalent diagnoses allows nurses to reinforce their commitment to managing cardiovascular conditions, improve care plans, and generate practice indicators for services, thus enhancing the quality of care provided.

Nursing interventions for the proposed nursing diagnosis of puerperal fatigue: An integrative review.

The postpartum period is considered a phase of many physiological and hormonal changes that affect the individual. Fatigue is something present and can influence the postpartum woman in a negative way. In this way, the nurse has an essential role, and the nursing process can be used to establish an efficient care plan. To present the main nursing interventions and activities of the nursing diagnosis (ND) fatigue (00093) in individuals/people in the immediate postpartum period obtained through an integrative literature review and correlate with the proposed ND puerperal fatigue/excessive burden of fatigue in the postpartum period. Integrative literature review, carried out in the databases Cochrane, Scopus and Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science (WoS), Virtual Health Library (VHL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL), following rigorous methodological standards. Six articles were included that identified the main nursing interventions related to the proposed ND puerperal fatigue. The integrative review highlighted the main nursing interventions and activities, and this study will be the basis for the next stages of the validation process for the ND puerperal fatigue/excessive fatigue in the postpartum period. This work can help nurses in clinical practice establish an efficient care plan through the most accurate nursing interventions and thus improve the quality of nursing services.

Construction of a care protocol following King's Goal achievement theory: experience report

Objective: to report the construction of a Care Protocol for the safe warming of hypothermic patients following Imogene King's Goal Achievement Theory. Method: this is an experience report from an intensive care nurse during the master's and doctorate course, where the protocol was developed, based on Imogene King's Theory. The experience was presented in five thematic axes. Results: In axis 1, there was a lack of monitoring of active heating, a lack of verbal and non-verbal communication, leading to the nursing diagnosis (axis 2) Hyperthermia and Hypothermia. In axis 3, a literature review (scope) was carried out to assess care for hypothermic patients. In axis 4, the content of the protocol was validated with the help of experts in the area and in axis 5, the aim is to evaluate the clinical feasibility of the protocol in everyday hospital settings. Conclusion: the study portrayed the construction of a protocol following Imogene King's Goal Achievement Theory, demonstrating the importance of developing tools to assist nursing in the treatment of hypothermic patients in hospitals.

The Application Of Medication And Strategies For The Implementation Of Hallucinations In Tn. S (Terra Neutral Separated) With A Nursing Diagnosis Of Sensory Perception Disorders (Hallucinations)

Hallucinations are sensory perception disorders that attack the five senses, where a person perceives an object or image and thoughts that do not occur or are not real. Hallucinations include sound, sight, taste, touch, or smell sensations without real stimulus. Treatment for patients with hallucinations is by identifying the type of hallucination, applying medication, and implementing strategies to distract or overcome the hallucinations experienced. The objectives of this study include (1) Describing problems regarding sensory perception disorders and (2) Describing and implementing nursing care in cases of mental disorders with a medical diagnosis of schizophrenia at Soerojo Hospital Magelang. This study uses a qualitative approach with case studies as the primary method, using observation sheets, interviews, and documentation studies. The subject of this study used one patient, Mr S, who had a nursing diagnosis of sensory perception disorders at RSD Soerojo Hospital Magelang. Nursing care for patient Mr S with a diagnosis of sensory perception disorder (hallucinations) in this case showed success as indicated by the signs and symptoms experienced by the patient decreasing. After four days of intervention, the patient was able to overcome hallucinations by scolding, interacting with the surrounding environment, and taking care of himself by bathing and dressing more neatly.

Nursing Variables Predicting Readmissions in Patients With a High Risk: A Scoping Review.

Unplanned readmission endangers patient safety and increases unnecessary healthcare expenditure. Identifying nursing variables that predict patient readmissions can aid nurses in providing timely nursing interventions that help patients avoid readmission after discharge. We aimed to provide an overview of the nursing variables predicting readmission of patients with a high risk. The authors searched five databases-PubMed, CINAHL, EMBASE, Cochrane Library, and Scopus-for publications from inception to April 2023. Search terms included "readmission" and "nursing records." Eight studies were included for review. Nursing variables were classified into three categories-specifically, nursing assessment, nursing diagnosis, and nursing intervention. The nursing assessment category comprised 75% of the nursing variables; the proportions of the nursing diagnosis (25%) and nursing intervention categories (12.5%) were relatively low. Although most variables of the nursing assessment category focused on the patients' physical aspect, emotional and social aspects were also considered. This study demonstrated how nursing care contributes to patients' adverse outcomes. The findings can assist nurses in identifying the essential nursing assessment, diagnosis, and interventions, which should be provided from the time of patients' admission. This can mitigate preventable readmissions of patients with a high risk and facilitate their safe transition from an acute care setting to the community.

Effects of traditional and dry bed baths on patients admitted in intensive units: A randomized crossover clinical trial.

The bed bath is an important part of nursing care. There are few studies evaluating the effects of traditional and dry bed baths on patients. This study was performed with the aim of investigating the effect of traditional and dry bed baths given to intensive care unit patients on the patients' hemodynamic parameters, the duration of the bathing procedure and the cost of consumable items. This was a randomized crossover clinical trial and a prospective study. The study was conducted in a General Surgery Intensive Care Unit with 22 intensive care patients aged 18 and over, who had a nursing diagnosis of bathing personal care deficiency. Each patient was given two types of bed baths at an interval of 24 h: a traditional bed bath and a dry bed bath performed with single-use tissues. Immediately before each bath, in the 5th, 10th and 15th minute of bathing, immediately after bathing and 30 min after bathing, body temperature, heart rate, blood pressure, breathing rate and peripheral oxygen saturation measurement changes over time were compared within the group using the Friedman test. The Wilcoxon signed ranks test was used to compare the variables of bathing duration and bathing consumable item costs between the bathing procedures. It was found that at the completion of traditional and dry bed bathing, the participants' body temperature, blood pressure, heart rate and breathing rate parameters were statistically significantly lower than before bathing, whereas peripheral oxygen saturation values showed a significant increase (p < 0.05). It was found that the dry bed bath took a statistically significantly shorter time than the traditional bed bath and that the cost of consumable bathing materials was less (p < 0.05). It was concluded that traditional and dry bed baths given to intensive care patients affected their hemodynamic parameters and that the dry bed bath was superior to the traditional bed bath in that it took less time and that it cost less.

Clinical validation of "spiritual distress (00066)" in parents of children with chronic diseases.

This study aimed to determine the clinical validation of the nursing diagnosis (ND) of "spiritual distress (00066)" and the sensitivity, specificity, likelihood ratio, and predictive value in parents of children with chronic diseases. This cross-sectional study was conducted using the clinical diagnostic validity method proposed by Fehring. The data were collected through structured interviews and using a researcher-made list that included 5 parts of demographic information, parents' opinions about spiritual distress, the researcher's diagnosis, 74 defining characteristics (DCs) of the ND of spiritual distress, and the Spiritual Well-being Questionnaire. Data were analyzed using descriptive statistics as well as sensitivity, specificity, likelihood ratio, and predictive value. The prevalence of diagnosis was 70% in a sample of 120 parents. Out of the 74 DCs, 39 criteria were validated. Questioning meaning of illness and suffering had the highest sensitivity (98.8%), the highest negative predictive value (88.88%), and the lowest negative likelihood ratio (0.05%). Expressing the lack of meaning in life demonstrated the highest specificity (97.22%), the highest positive predictive value (98.33%), and the highest positive likelihood ratio (25.26%). Parents who search for meaning of illness and suffering related to a lack of meaning in life are in spiritual distress. The ND was validated. These findings can empower clinical nurses to confidently assess and identify patients experiencing spiritual distress, bridging the gaps caused by the absence of standardized tools for assessing spiritual distress in the inpatient setting.

Sosialisasi Pencegahan Demam Berdarah Dengue pada Anak Sekolah Dasar Dusun Setro Kecamatan Bergas Kabupaten Semarang

One way to raise awareness of love for the environment and prevent dengue hemorrhagic fever is through outreach to school children. Socialization is one way to increase knowledge about preventing dengue hemorrhagic fever. The outreach aims to control the increasing incidence of dengue hemorrhagic fever cases. The method used begins with observation and giving a questionnaire to be filled in regarding questions regarding dengue hemorrhagic fever. After the data is found, a nursing diagnosis is then formulated, followed by implementation activities in the form of edugames and community service. Pre post analysis of knowledge using the Wilcoxon test showed that the p value (0.000) showed that there was an increase in knowledge between before and after socialization.

Making room for occupational health nursing in Nanda‐I: “Impaired foot health” as a diagnosis

Discuss the label "impaired foot health" to be considered a problem-focused nursing diagnosis according to the taxonomy of NANDA-I. Discussion article based on literature reviews and observational studies based on the authors' PhD ongoing research about foot health among nursing students and professionals. Attending to the definition of nursing diagnosis and the scope of nursing practice internationally, several human responses and contexts should be considered, opening new opportunities for NANDA-I completeness. A new nursing diagnosis has been disclosed, opening new dimensions to the NANDA-I taxonomy. This nursing diagnosis represents an opening door for the taxonomy, particularly for occupational health nursing in an international context.

Representing Nursing Practice in EMR/EHRs.

Review of the ISO 18104 technical standard for a Nursing Categorial structure to best represent nursing practice in EMR/EHRs and digital health ecosystems. Application of ISO standard review guidelines in consultation with ISO member stakeholders. Comprehensive views of the nursing practice knowledge domain are presented as mindmaps. Groups of patients can now be identified using the 'type of subject of care' category. The collaborative role of nurses is now recognized. This high level structured information model recognises nursing diagnosis, nursing actions and nurse sensitive outcomes relative to other categories and sub-categories known to influence nursing actions and nurse sensitive outcomes. This nursing practice framework reflects the nursing process. It supports conceptual and logical analysis of patient journey related nursing practice. This updated categorial structure is a good fit with today's information technologies. Its adoption enables the value of nursing services provided to be demonstrated.

The importance of family nurses' participation in the local program of cardiological prevention in Wroclaw

Abstract In Poland, cardiac prevention programs minimize the nurse's role in health education related the patient's lifestyle change. Following the experience of Swedish primary health care, the Health Department of the City Hall in Wrocław was the first local government to launch a long-term, ten-year preventive cardiology program in 1998. Aim of the study To present the participation of family nurses in the implementation of population intervention program in cardiological prevention among the inhabitants of Wrocław. Material and method The general practitioners from Wrocław and a group of 100 family nurses participated in the preventative program. The overall goal of the program was to assess risk factors for cardiovascular disease. Each patient was provided with education by the nurse. To conduct the nursing visit, a procedure was used that took into account the structure criteria and the a unified procedure criteria. The nurses analyzed the norms of laboratory test results, blood pressure, heart rate, weight, height, fiber and fat intake, and calculated BMI and WHR. The nurses used a health profile. If a patient was considered a person from a higher risk group, they provided referred the patient to a general practitioner. Conclusions In local prevention program, residents were motivated to modify health behaviors through nursing diagnosis and assessment. The close place of residence and direct contact with the patient made it possible to provide health education focused on first-degree prevention. However, patient health education requires organization, time and communication skills, which is why it is so important to prepare staff to implement preventive programs and finance them from local funds. The new role of a health educator becomes an opportunity to change the perception of the traditional role of nursing.