Nursing Diagnosis Research Articles

Nursing Care in Tn. B And Tn. S with Disorders of Sensory Perception: Hallucinations


 
 
 
 This study aims to explain and evaluate the implementation of nursing care for patients who experience auditory hallucinations. The research method uses a case study approach by collecting data from initial assessments, nursing diagnoses, care plans, nursing interventions, evaluations, and discharge planning. The research results show that an initial assessment is carried out by identifying mental health history, behavior related to hallucinations, and triggering factors that may influence the patient's condition. The nursing diagnosis was determined as sensory perception disorder: auditory hallucinations. The treatment plan involves collaboration with the mental health team, behavioral monitoring, emotional support, and education of the patient and family. Nursing interventions include explanation of the nature of hallucinations, assistance in identifying reality, and use of relaxation and distraction techniques. Evaluations are carried out to assess the patient's response to the interventions provided and monitor changes in the intensity or frequency of hallucinations, discharge planning and provide information regarding warning signs. Conclusion: Nursing care for patients with sensory perception disorders requires a holistic approach and collaboration between nurses and the mental health team. Education for patients and families also has an important role in supporting the management of this condition.
 
 
 
 

Nursing Care in Hallucination Patients


 
 
 
 The aim of this study was to examine the implementation of nursing care for two patients who experienced hallucinatory sensory perception disorders. The research method uses a case study approach with data analysis through medical records, observations, and interviews with patients and families. The results showed that both patients experienced sensory perception disorders in the form of auditory hallucinations. The initial assessment includes identification of mental health history, observation of hallucinatory behavior, and precipitating factors. The nursing diagnosis was determined as sensory perception disorder: hallucinations. The treatment plan involves collaboration with the mental health team, use of drug therapy prescribed by the doctor, as well as nursing interventions such as education about stress management, distraction techniques, and increased coping. Evaluations are carried out periodically to monitor the patient's response to the interventions provided. The conclusion of this study is that nursing care for patients with sensory perception disorders requires a comprehensive approach that includes collaboration between nurses, mental health teams and families in order to help improve the quality of life of patients with sensory perception disorders, especially in managing the symptoms of hallucinations.
 
 
 
 

Nursing Care in Risk of Violent Behavior


 
 
 
 The aim of this research is to analyze and design nursing care for two patients, who are at risk of violent behavior. Observations, interviews, and medical record documentation studies are data collection methods. Based on the research results, it is known that both patients have a high risk of violent behavior, especially related to a history of previous violence and underlying mental disorders. Initial assessment includes identification of potential triggers for violence, evaluation of level of coping, and assessment of social support. Risk of violent behavior is the patient's second nursing diagnosis. Treatment plans are implemented with a focus on violence prevention, involving collaboration with a multidisciplinary team, including medical personnel, and psychiatrists. Nursing interventions involve therapeutic approaches to improve coping, interpersonal skills training, and close monitoring for signs of violence. Periodic evaluations are conducted to assess the effectiveness of the treatment plan and identify changes in patient behavior. Discharge planning involves coordination with family and mental health services in the community to ensure continuity of care after discharge. The conclusion of this research is that nursing care for patients at risk of violent behavior requires a careful, proactive and collaborative approach. Implementing integrated violence prevention strategies and close monitoring can help reduce the risk of violent incidents.
 
 
 

Middle range theory for the nursing phenomenon Ineffective social support network.

To describe a middle range theory (MRT) with conceptual and explicative capacity of cause and effect situations of Ineffective social support network in nursing. Descriptive study developed through the Lopes, Silva, and Herdman theoretical-causal validity method, using five steps for theory construction: definition of the approach for constructing the MRT, definition of the main concepts, development of the pictorial diagram, construction of propositions, and establishment of causal relationships and evidence for practice. The foundation of these steps and the development of a predictive nursing theory occurred through Sanicola's Social Network Theory combined with studies from an integrative literature review using the six steps proposed by Whittemore and Knafl. The theory presents etiological factors and clinical indicators for Ineffective social support network, connecting situations related to the person, the members and the configuration of this network, and external situations. The pictogram, symbolically created, represents the hierarchical classification of proximal, intermediate, and distal etiological factors, and their relationship with clinical indicators. The MRT, predictive for the nursing phenomenon Ineffective social support network, provides understanding of the person from an interpersonal perspective, which interferes with and is affected by a network of virtues and vicissitudes, and has negative influences on health outcomes. Due to its practical vocation, this theory represents an advance in the science and praxis of nursing. The findings of this study will contribute to the understanding of the nursing phenomenon Ineffective social support network and consequently support the identification of the nursing diagnosis Ineffective social support network, proposed for inclusion in the NANDA-I classification.

Specific causal validation of nursing diagnosis Risk for thrombosis: A case-control study.

This study aims to perform specific causal validation of nursing diagnosis Risk for thrombosis (00291) of the NANDA International (NANDA-I) classification. This is a case-control study conducted in a university hospital from January to October 2020. A total of 516 adult patients were included-344 in the Case Group (with venous or arterial thrombosis evidenced by imaging) and 172 in the Control Group (without thrombosis). Statistical analysis was performed by univariate and multivariate logistic regression test, and odds ratios were calculated to measure the effect of exposure between groups. The study was approved by the Research Ethics Committee. The patients were predominantly female and aged 59±16 years. In the univariate logistic analysis, five risk factors were significantly associated with thrombosis, two at-risk populations and 12 associated conditions. In the multivariate regression model, the following risk factors remained independently associated (p<0.05): inadequate knowledge of modifiable factors (OR: 3.03; 95% CI: 1.25-8.56) and ineffective medication self-management (OR: 3.2; 95% CI:1.77-6.26); at-risk populations with history (OR: 2.16; 95% CI: 1.29-3.66) and family history of thrombosis (OR:2.60; 95% CI: 1.03-7.49); and the conditions associated with vascular diseases (OR:6.12; 95% CI:1.69-39.42), blood coagulation disorders (OR: 5.14; 95% CI:1.85-18.37), atherosclerosis (OR:2.07; 95% CI: 1.32-3.27), critical illness (OR: 2.28; 95% CI: 1.42-3.70), and immobility (OR: 2.09; 95% CI: 1.10-4.12). The clinical validation allowed to establish strong evidence for the refinement of the diagnosis Risk for thrombosis and, consequently, to raise its level of evidence in the classification of NANDA-I. The evidence pointed out by this study favors the establishment of thrombosis diagnosis in an accurate way by nurses in clinical practice, directing preventive interventions to patients in this risk condition.

Nursing care plan on gas exchange impairment due to SARS-CoV-2: case report

INTRODUCTION: Over the years, mankind has been in contact with several viruses, which have threatened human existence by becoming pandemics such as influenza in 1918. However, in January 2020, the Chinese Centre for Disease Control and Prevention identified SARS-CoV-2 as the etiological agent of the 2019 coronavirus. So far it is known that 5% of patients with severe COVID-19 will require attention in intensive care units. To this end, critical care nursing staff use the nursing care process to prioritize the care of the critically ill patient. OBJECTIVE: To develop a nursing care plan by analyzing a clinical case of an adult patient with a diagnosis of COVID-19. METHODOLOGY: The case of a patient with a diagnosis of COVID-19 was analyzed to develop a nursing care process using the taxonomies of the North American Nursing Diagnosis Association, Nursing Interventions Classification and Nursing Outcomes Classification. Documentary research was carried out through a literature search in databases such as: Scielo, Medicgraphic, Google Scholar and PubMed. RESULTS: Three real nursing diagnoses and seven risk diagnoses were identified. The priority nursing diagnostic label based on Maslow's pyramid of needs was deterioration of related gas exchange. CONCLUSIONS: The critical care nurse takes a leading role in the care of patients with a diagnosis of COVID-19, the development of the nursing care process contributes to providing quality care focused on the well-being of the user.

Structural validity of nursing diagnosis insomnia in older adults of a community center.

Insomnia is an important sleep disorder in older persons. Conceptual analysis studies on this nursing diagnosis have been developed, but the diagnostic accuracy has not been verified. This study aimed to verify the diagnostic accuracy of the nursing diagnosis of Insomnia (00095) in older adults in a community center in Brazil. A validation study for diagnostic accuracy of the defining characteristics of the nursing diagnosis Insomnia. Data were collected through telephone interviews with 90 participants. Latent class analysis was used to verify the sensitivity and specificity of the defining characteristics. Poisson regression was used to assess the prevalence of the association of factors related to the nursing diagnosis of insomnia. A 47.42% prevalence of insomnia in the sample was identified. Defining characteristics such as expresses dissatisfaction with sleep and nonrestorative sleep-wake cycle showed the best accuracy values for insomnia, with a specificity of 0.92 (0.78-1.00) and 0.89 (0.74-1.00), respectively. Related factors such as stressors and frequent naps during the day were more likely to develop insomnia in individuals. This study indicates diagnostic accuracy of nursing diagnosis of insomnia in community-dwelling older people from a community center. The findings highlighted the importance of the defining characteristics of nursing diagnosis insomnia and its main related factors contributing to accurate diagnostic identification. This study can contribute to providing objective clinical indicators of insomnia in the older population to guide nurses in early diagnostic confirmation for the selection of health interventions. In addition, it can be a consistent contribution to theoretical and conceptual reviews ofthisdiagnosis.

Situation-Specific Theory from Autonomic Dysreflexia Nursing Diagnosis Based on Roy’s Adaptation Model

Introduction: Autonomic dysreflexia (AD) is a condition developed secondary to a spinal cord injury, which manifests with the loss of coordinated autonomic responses and cardiovascular control. For the care of the person, the nurse has the nursing diagnosis of AD, which allows the precise interpretation of the human responses of each individual. However, it is necessary to strengthen and update the diagnosis to the new disciplinary knowledge that evolved with nursing practice. For this, proposing a situation-specific theory is essential to explain the phenomenon of interest and guide practice. Objective: To construct a situation-specific theory for the nursing diagnosis of AD derived from the adaptation model of Sor Callista Roy. Materials and methods: Theoretical study developed in five stages: defining the approach to construct the theory, defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. Results: The situation-specific theory included defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. We described the concepts and their relationships through seven propositions and identified 19 ineffective behaviors and 43 environmental stimuli. Of them, 39 are focal, and four are contextual stimuli. Conclusions: This situation-specific theory offers a substantiated and comprehensive explanation of the human response to AD for supporting nursing care.

Developing a Mobile Learning Virtual Nursing Diagnosis (VND) Media for Medical Surgical Nursing Course

Link of Video Abstract: https://youtu.be/4zHCrIC1IGE Background: The development of innovative and technology-aligned learning media is a necessary solution for nursing students. Students require access to interactive, practical, and easily accessible learning resources. An application that can facilitate students' learning in nursing diagnosis for surgical nursing, such as Virtual Nursing Diagnosis (VND), is needed. This study focuses on the development of the VND application specifically designed for the Surgical Nursing Care course. Patients and methods: The research is a Research and Development (R&amp;D) study involving 253 nursing students from Aceh Health Polytechnic. A needs analysis was conducted to identify the difficulties faced by students in applying nursing diagnoses to topics related to surgical nursing, particularly the cardiovascular system. Based on the findings of the needs analysis, it was discovered that students face difficulties in determining nursing problems. Therefore, the VND application was developed with features such as assessment forms, assessment tools, disease pathology, and nursing diagnoses. Additionally, the application is equipped with competency tests on interesting nursing cases that are user-friendly for students. Results: The research results indicate that the VND application has received positive feedback from 253 students who have used it in real classroom environments. The application is user-friendly, efficient in performing nursing diagnoses, and provides available nursing case questions. VND application provides an interactive, innovative, and effective learning tool for understanding nursing diagnoses while enhancing accessibility and flexibility through mobile-based learning. The application equips students with the necessary skills to apply nursing diagnoses in real-world surgical medical practice. Conclusion: the VND application significantly contributes to the development of nursing education. It not only improves understanding of nursing diagnoses but also provides an engaging and interactive learning experience. It is hoped that the use of the VND application in surgical nursing education can be an effective and innovative solution to enhance competency in applying nursing diagnoses in clinical practice.

Postural Orthostatic Tachycardia Syndrome: Diagnosis and Management Guide for Nurses

Postural Orthostatic Tachycardia Syndrome: Diagnosis and Management Guide for Nurses

Configuring a computer-based nursing process form to support nursing diagnosis in rural healthcare clinics in Nigeria.

Poor internet infrastructure limits the use of computer-based nursing process forms in rural areas. This study aimed to configure a computer-based nursing process form to support nursing diagnosis and care evaluation in rural healthcare clinics in Africa. This study utilized a methodological design. The design process utilized a three-stage procedure involving planning, configuration, and testing. Seven faculty members volunteered to participate in the laboratory verification process. Each simulation session lasted 45 min and span from patient admission to exit. The experts independently scored the software functionality dichotomously as Not Suitable (score 0) and Suitable (score 1) for nursing practice. The agreement between the faculty volunteers was 0.857. The configuration of a readily available Microsoft Access computer application to support nursing diagnosis without internet service is possible. Health facilities in rural areas without internet connectivity should resort to such local configurations to maximize the benefits of electronic-based documentation.

Use of Physical Assessment Knowledge Skills and Educational Requirement Levels of Emergency Nurses: A Quantitative Study

Physical assessment, which is a professional nursing practice, is an important component in making a nursing diagnosis, planning patient-centered goals, and evaluating patient outcomes by making appropriate interventions. The research has been done to determine the level of information and skill about the physical assessment and training requirements of emergency nurses. The descriptive research has been done with the participation of 130 nurses, who are working in adult emergency room. The data has been collected with nurse information form and physical assessment skills assessment form. It was determined that the physical assessment skills of the nurses, which had the highest level of knowledge and skill, were vital findings, skin and neurological evaluation, and the evaluation of genitourinary system was the lowest. Nurses stated that they need training for heart-peripheral vascular system, thorax-lung and neurological assessment. In the research, it is determined that the nurses did not use physical assessment skills at desired level. Although the physical assessment knowledge and skill levels of some nurses were high and the frequency of application was high, it was found that the nurses who see physical assessment among their roles were high in the training requirements related to the same fields.

Nursing Care For Families With A Deficit Of Hypertension-Related Knowledge At The Surabaya Health Centers Working Area : A Case Study

Introduction: Hypertension is the main cause of death worldwide, this condition continues to increase from year to year related to cardiovascular and kidney disease. The purpose of this case study is to explain how nursing care is given to families with knowledge deficits about hypertension at the Surabaya Health Center. Methods: This case study uses a single case study design with a sample of families with knowledge deficits in hypertension. Data were collected by primary methods, namely interviews with families and secondary methods, namely conducting physical assessments. The intervention carried out was health education in accordance with the Indonesian Nursing Diagnosis Standards which was carried out for 7 days. Results: After the family was given hypertension health education interventions and hypertension exercises, the family experienced an increase in knowledge related to hypertension with a pre-test score of 2 to a post-test score of 10. The family was able to control their diet and was committed to having their health checked regularly, and the family was able to carry out activities. physical exercise with hypertension independently at home. Conclusion: The results of the evaluation are that there is an increase in the level of knowledge in the family and able to carry out healthy lifestyle management by controlling diet, doing hypertension exercises independently at home and committed to carrying out regular health checks. It is expected that health workers will socialize and train the skills of implementing hypertension gymnastics so that they can carry out the management of patients who experience hypertension by means of non-pharmacological management to control blood pressure in hypertensive patients

Gambaran Diagnosis Keperawatan Pada Pasien Diabetes Melitus di Rumah Sakit Umum Daerah Tugurejo Semarang

DM (Diabetes Mellitus) is a metabolic disorder characterized by insulin hormone deficiency. Patients with DM exhibit various signs and symptoms, which serve as the basis for nursing diagnoses by nurses. This study aims to describe nursing diagnoses in DM patients at Tugurejo Hospital in Semarang. The research design employed was quantitative research using a survey analysis approach of medical record documents. The sample consisted of 112 medical record documents of DM patients who were hospitalized at Tugurejo Hospital in Semarang from October to December 2022. Data were analyzed using univariate analysis (descriptive analysis) with frequency distribution. Data were collected using a nursing diagnosis checklist that had been adapted to the Indonesian Standard Classification of Diseases. The results showed that the majority of DM patients were aged 45-60 years (54%), and the majority were female (61%). The most frequently occurring nursing diagnoses in DM patients were acute pain (46.4%), unstable blood glucose levels (45.5%), and impaired skin/tissue integrity (22%). The other frequently occurring nursing diagnosis was nausea (16%). The majority of nursing diagnoses were actual nursing diagnoses. Nurses and hospitals are expected to meet the basic needs of DM patients, especially in addressing acute pain issues.

Romanian nurses' beliefs on nursing diagnosis. A survey study based on the theory of planned behavior.

To identify clusters of beliefs about nursing diagnosis (ND) among Romanian hospital nurses and to ascertain variations in attitudes, intention to use, behavior associated with the use of ND, and sociodemographic characteristics. A cross-sectional online survey study was conducted on a convenience sample of 498 hospital nurses in Romania. The questionnaire comprises six scales measuring normative, behavioral, and control beliefs, intention to use, attitudes, and behavior toward ND. Results were reported through cluster analysis. Three clusters were identified: highly positive, average, and highly negative beliefs about ND. Romanian nurses have more homogeneous beliefs regarding ND than nurses from other countries. Comparisons among clusters showed significant differences in intention [H(2)=111.59, p<0.001], attitudes [H(2)=145.27, p<0.001], and reported behavior [H(2)=43.84, p<0.001]. The stronger the attitude toward ND, the intention to use it, and the behavior of using ND, the more favorable the beliefs and vice versa. Significant disparities among clusters were discovered regarding education in ND, whereas differences were not observed regarding years of experience, age, and gender. Nurses exhibited different belief patterns about ND. Those with more positive beliefs demonstrated a more favorable attitude, a higher intention, and a more frequent behavior in using ND. Training in ND facilitates positive beliefs about it. When designing interventions to promote ND in clinical practice, policymakers, administrators, and educators should consider addressing and potentially changing these beliefs. Modifying nurses' attitudes could positively impact patient care quality during their hospital stay and post-discharge.

Association between health literacy and nursing care in hospital: A retrospective study.

To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks. Retrospective study. The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single-Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs. Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care. The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes. HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge. No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection.

Strategi Implementasi Diagnosis, Intervensi dan Luaran Keperawatan Indonesia terhadap Perawat

This study explores strategies for implementing Indonesian nursing diagnoses, interventions, and outcomes for hospital nurses. This research method uses a scoping review approach. The research results found 12 articles that describe seven main components of strategies for implementing standard diagnosis, intervention, and outcomes of Indonesian nursing, namely educational programs, case study discussions, assistance using instruments, observation, innovation, role play, and demonstration. Conclusion The strategy for implementing training, case study discussions, and service using devices, words, innovation, role play, and demonstrations can increase nurses' knowledge and skills in nursing practice and patient safety using Indonesian hospital nursing standards.&#x0D; &#x0D; Keywords: Indonesia, Nurses, SDKI SLKI SIKI, Standardization

Fatigue in patients with heart failure: A study of diagnostic accuracy fatigue in patients with heart failure.

To analyze the accuracy of defining characteristics of the NANDA International nursing diagnosis, fatigue (00093), in patients with heart failure. A cross-sectional study on the diagnostic accuracy of the defining characteristics of the nursing diagnosis. The sample consisted of 96 patients with heart failure in treatment in a public hospital. The latent class analysis method was used to test the accuracy measurements and estimate the prevalence of the diagnosis. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte. The prevalence of the fatigue nursing diagnosis was 42.54%. Increased physical symptoms (0.9988) and tiredness (0.9988) were the sensitive defining characteristics. Disinterested in surroundings (0.9999) was the specific defining characteristics. A set of three defining characteristics of the nursing diagnosis of fatigue was accurate in patients with heart failure. Thus, this set can be used by nurses to confirm nursing diagnosis fatigue in patients with heart failure. This research contributes by providing accurate defining characteristics of fatigue in patients with heart failure. Thus, nurses should recognize the nursing diagnosis of fatigue in patients with heart failure through accurate defining characteristics and propose rapid and effective nursing interventions that have positive health results.

The effect of virtual game simulation on students' perception of nursing diagnosis and clinical practice: Post-test only randomized controlled trial

BackgroundThe virtual game simulation was prepared for nursing diagnosis and goal setting. ObjectivesTo determine the effect of virtual game simulation on nursing students' perception of nursing diagnosis and clinical practice. DesignThis study is a post-test randomized controlled trial only. MethodsThe study was conducted with 92 s-year students enrolled in the Nursing Department of a state university in a province of Turkey. Data were collected using the Descriptive Characteristics Form, Perceptions of Nursing Diagnoses Survey, and the Form for Evaluating the Effect of Virtual Game Simulation on Clinical Practice. Virtual game simulations, which are prepared for determining nursing diagnosis and creating goals, are offered to the use of first-year students after the theoretical education of the nursing process. In order to evaluate the effect of virtual game simulations on the perception of nursing diagnosis and clinical practice, second-year students who played the game voluntarily were included in the experimental group, and those who did not play were included in the control group. Students in the control (n = 46) and experimental (n = 46) groups completed the data collection tools prepared online via Google Forms. The relationship between the grouped variants was tested by Chi-Square (χ2) analysis. Mann-Whitney U-test was used because the data did not show normal distribution. ResultsIt was found that the mean score of the control group was significantly higher than the experimental group in the sub-dimension of the delineation and promotion of the nursing profession and in the total score of the Perceptions of Nursing Diagnoses Survey (PNDS) (p < 0.05). The students in the experimental group made positive statements about the effect of the virtual game simulation on clinical practice, such as, "I can determine nursing diagnoses correctly", "I can create the right target for the patient", and "I understand how to record the data I collect from the patient". The negative statements of the students were as follows: "I have difficulty in collecting data from the patient", "I have difficulty in interviewing the patient" and "I cannot be sure that I have determined all the nursing diagnoses for my patient". ConclusionsVirtual game simulation was found to be effective in students' perception of nursing diagnosis. It was noted that most of the students expressed positive views regarding the impact of virtual game simulations on clinical practice. It is recommended to use virtual game simulation to support formal education in teaching the nursing process.

Web-based standardized patient simulation for taking anamnesis: an approach in nursing education during the pandemic

BackgroundTo address the challenges in nursing education brought about by the pandemic, this study aimed to evaluate the use of a web-based standardized patient practice in the development of nursing students’ anamnesis taking skills and their views about its application.MethodWe conducted a descriptive intervention study with 39 s-year nursing students. The students completed anamnesis using the standardized patient practice in line with a scenario with real standardized patients in a web-based environment with audio and video.ResultsThe total scores of students’ anamnesis skills were low. The agreement between the total scores, scores obtained from the health patterns, and each item in the control list was statistically significant (p < 0.05).ConclusionWeb-based standardized patient practice is an alternative for clinical practice facilitating the gaining of competencies in making holistic nursing diagnoses under conditions that limit face-to-face interactions, such as pandemics.