NANDA Research Articles

“Does One Size Fit All?” Exploring the Cultural Applicability of NANDA Nursing Diagnoses to Chinese Nursing Practice

East Asia has historically unique concepts of health and well-being and thus is an appropriate setting for exploring the multicultural applicability of the North American Nursing Diagnosis Association's Nursing Diagnoses (NANDA ND) system. This study aimed to explore how NANDA ND affect the growth and quality of professional nursing from the perspective of Taiwanese nurses. Grounded theory was employed in this interview-based investigation of 53 Taiwan-licensed nursing professionals at various hospitals in Taiwan. Data were analyzed using constant comparative analysis until theoretical saturation was reached. The core concept, Struggling with (the NANDA ND notion that) One Size Fits All, emerged after ongoing analysis of the effects of NANDA ND on good nursing, patient welfare, and professional development. The preliminary theoretical framework developed from this study provides evidence that NANDA ND may be incompatible with the cultural beliefs of the traditional Chinese health care setting in Taiwan, which emphasize holistic harmony and balance.

Risco de quedas em idosos: revisão integrativa pelo diagnóstico da North American Nursing Diagnosis Association

Foi objetivo desta pesquisa analisar a produção científica de fatores de risco para quedas, a partir do diagnóstico da North American Nursing Diagnosis Association, na literatura científica brasileira e estrangeira, de 2005 a 2010. Revisão integrativa, na qual foram utilizados os descritores: acidente por quedas e idoso, nas bases de dados da Cumulative Index to Nursing and Allied Health Literature e Literatura Latino-Americana e do Caribe em Ciências da Saúde, sendo selecionados 32 artigos para análise de conteúdo. Os resultados são apresentados conforme os fatores de riscos indicados na North American Nursing Diagnosis Association, sendo eles: fatores de riscos ambientais, como recinto com móveis e objetos/tapetes espalhados pelo chão, pouca iluminação, piso escorregadio; fatores de riscos cognitivos, tais como estado mental rebaixado; fatores de riscos em adultos, como idade acima de 65 anos; fatores de riscos fisiológicos, como equilíbrio prejudicado, dificuldades visuais, incontinência, dificuldade na marcha, neoplasia; fatores de riscos para uso de alguns medicamentos. A análise dos fatores de risco de quedas nos idosos evidência a necessidade de desenvolvimento de novas estratégias modificadoras dos ambientes e componentes intrínsecos.

Nursing diagnoses related to skin: operational definitions

to validate the operational definitions of the defining characteristics and risk factors of the three NANDA International (NANDA-I) nursing diagnoses and to revise these diagnoses' definitions. content validation of nursing diagnosis. 146 defining characteristics and risk factors were identified in the literature in Brazilian and international databases. This was followed by content validation of the definitions of these diagnoses (presented by NANDA-I) and of the operational definitions (developed by the researchers) of the defining characteristics and risk factors, carried out by six expert nurses, regarding relevance, clarity and comprehensiveness. of the 146 defining characteristics and risk factors, 22 were considered redundant and were excluded. The experts proposed changing the definitions of the diagnoses of Impaired Tissue Integrity and Risk for Impaired Skin Integrity. It was possible to identify various defining characteristics and risk factors which are not present in the NANDA-I taxonomy but which are indicated in the literature. the process attained its objective of producing valid operational definitions for defining characteristics and risk factors, which will permit the undertaking of validation studies for these diagnoses. The study's contribution to advancing scientific knowledge consists in its presenting clearer operational definitions for these diagnoses and a higher number of defining characteristics and risk factors, which will assist the nurses in the identification and use of the same with greater accuracy in clinical practice.

Effectiveness of Standardized Nursing Care Plans in Health Outcomes in Patients with Type 2 Diabetes Mellitus: A Two-Year Prospective Follow-Up Study

BackgroundImplementation of a standardized language in Nursing Care Plans (SNCP) allows for increased efficiency in nursing data management. However, the potential relationship with patientś health outcomes remains uncertain. The aim of this study was to evaluate the effectiveness of SNCP implementation, based on North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classification (NIC), in the improvement of metabolic, weight, and blood pressure control of Type 2 Diabetes Mellitus (T2DM) patients.MethodsA two-year prospective follow-up study, in routine clinical practice conditions. 31 primary health care centers (Spain) participated with 24,124 T2DM outpatients. Data was collected from Computerized Clinical Records; SNCP were identified using NANDA and NIC taxonomies. Descriptive and ANCOVA analyses were conducted.Results18,320 patients were identified in the Usual Nursing Care (UNC) group and 5,168 in the SNCP group. At the two-year follow-up, the SNCP group improved all parameters except LDL cholesterol and diastolic blood pressure. We analyzed data adjustming by the baseline value for these variables and variables with statistically significant differences between groups at baseline visit. Results indicated a lowering of all parameters except HbA1c, but a statistically significant reduction was only observed with diastolic blood pressure results. However, the adjusted reduction of diastolic blood pressure is of little clinical relevance. Greater differences of control values for diastolic blood pressure, HbA1c, LDL-cholesterol and Body Mass Index were found in the SNCP group, but only reached statistical significance for HbA1c. A greater proportion of patients with baseline HbA1c ≥7 decreased to <7% at the two-year follow-up in the SNCP group than in the UNC group (16.9% vs. 15%; respectively; p = 0.01).ConclusionsUtilization of SNCP was helpful in achieving glycemic control targets in poorly controlled patients with T2DM (HbA1c ≥7%). Diastolic blood pressure results were slightly improved in the SNCP group compared to the UNC group.Trial RegistrationClinicalTrials.gov NCT01482481

Mapping the Diagnosis Axis of an Interface Terminology to the NANDA International Taxonomy

Background. Nursing terminologies are designed to support nursing practice but, as with any other clinical tool, they should be evaluated. Cross-mapping is a formal method for examining the validity of the existing controlled vocabularies. Objectives. The study aims to assess the inclusiveness and expressiveness of the nursing diagnosis axis of a newly implemented interface terminology by cross-mapping with the NANDA-I taxonomy. Design/Methods. The study applied a descriptive design, using a cross-sectional, bidirectional mapping strategy. The sample included 728 concepts from both vocabularies. Concept cross-mapping was carried out to identify one-to-one, negative, and hierarchical connections. The analysis was conducted using descriptive statistics. Results. Agreement of the raters' mapping achieved 97%. More than 60% of the nursing diagnosis concepts in the NANDA-I taxonomy were mapped to concepts in the diagnosis axis of the new interface terminology; 71.1% were reversely mapped. Conclusions. Main results for outcome measures suggest that the diagnosis axis of this interface terminology meets the validity criterion of cross-mapping when mapped from and to the NANDA-I taxonomy.

Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: A nursing approach

PurposeTo develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I). MethodsA fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. The model was implemented in Microsoft Visual C++® Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). The sensitivity and specificity of the model were calculated considering the expert's opinion as a gold standard. In order to compute the Kappa's values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different. ResultsThe overestimation of the accordance showed an excellent agreement (kappa=0.92, p<0.0001); and the underestimation provided a moderate agreement (kappa=0.42, p<0.0001). In general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42). ConclusionsThe decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view. LimitationsIn spite of the good results, the FCM should be improved to identify the diagnoses of urge urinary incontinence and total urinary incontinence.

Nutrition education intervention for dependent patients: protocol of a randomized controlled trial

BackgroundMalnutrition in dependent patients has a high prevalence and can influence the prognosis associated with diverse pathologic processes, decrease quality of life, and increase morbidity-mortality and hospital admissions.The aim of the study is to assess the effect of an educational intervention for caregivers on the nutritional status of dependent patients at risk of malnutrition.Methods/DesignIntervention study with control group, randomly allocated, of 200 patients of the Home Care Program carried out in 8 Primary Care Centers (Spain). These patients are dependent and at risk of malnutrition, older than 65, and have caregivers. The socioeconomic and educational characteristics of the patient and the caregiver are recorded. On a schedule of 0–6–12 months, patients are evaluated as follows: Mini Nutritional Assessment (MNA), food intake, dentures, degree of dependency (Barthel test), cognitive state (Pfeiffer test), mood status (Yesavage test), and anthropometric and serum parameters of nutritional status: albumin, prealbumin, transferrin, haemoglobin, lymphocyte count, iron, and ferritin.Prior to the intervention, the educational procedure and the design of educational material are standardized among nurses. The nurses conduct an initial session for caregivers and then monitor the education impact at home every month (4 visits) up to 6 months. The North American Nursing Diagnosis Association (NANDA) methodology will be used. The investigators will study the effect of the intervention with caregivers on the patient’s nutritional status using the MNA test, diet, anthropometry, and biochemical parameters.Bivariate normal test statistics and multivariate models will be created to adjust the effect of the intervention.The SPSS/PC program will be used for statistical analysis.DiscussionThe nutritional status of dependent patients has been little studied. This study allows us to know nutritional risk from different points of view: diet, anthropometry and biochemistry in dependent patients at nutritional risk and to assess the effect of a nutritional education intervention. The design with random allocation, inclusion of all patients, validated methods, caregivers’ education and standardization between nurses allows us to obtain valuable information about nutritional status and prevention.Trial Registration numberClinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01360775

Nursing process as a strategy in the development of competence for self-care

OBJECTIVE: To investigate the contribution of clinical care and education of nursing in a hospital context, in the development of competence for self-care for people with chronic renal failure. METHODS: A case study conducted with a patient during hospitalization in Fortaleza, through the nursing process proposed by Orem determining deficiencies and enabling self-care demands satisfaction from him. RESULTS: The requisites of therapeutic self-care d.emands of health deviation sef-care requisites enabled the identification of three nursing diagnoses based on the North American Nursing Diagnosis Association - NANDA for which interventions were defined based on NIC and results according to NOC. CONCLUSION: In the hospital context, clinical and educational nursing care based on the nursing process proposed by Orem contributes as a facilitator for the development of competence for self-care in people with chronic disease.

Cuidando a un preescolar desde el modelo de activos en salud: caso clínico

The health assets model is a field of work that has protective effects on children associated with the protection, safety, and to their well being. This assets model is complementary, to the deficit model, which is often absent. From this point of view, we present the case of a 4 year old who was healthy and for whom a series of activities were designed with parents as primary implementers and directed primarily to the maintenance of health and child welfare. To do this, a care plan for parents caring for the learning child was developed based NANDA nursing taxonomy, and the NOC and NIC classifications in order to achieve the desired outcomes and carry out the appropriate nursing interventions. From the methodological point of view, possessing a common language and a nursing diagnostic taxonomy are keys to the development of our profession, but to work from a salutogenic perspective based on the NANDA International diagnoses, we believe that this does not fit properly. There is a lack of development in this area and would be interesting to develop it.

Identification risk for falls diagnosis in the elderly serviced by the elderly care program

ABSTRACT Objective: identifying the frequency of nursing diagnosis Risk for falls in the elderly and assess their risk factors. Method: retrospective study based on data recorded in the medical records of elderly patients in the Elderly Care Program. Data collection was done between May-June 2009, by means of a questionnaire with information on the epidemiological and diagnostic study, classified according to the North American Nursing Diagnosis Association (NANDA-I), after approval by the Ethics Committee of the Federal University of Alfenas (protocol 23087.001613/2009-01). For tabulation and analysis of data the statistical program Statistical Package for Social Sciences (SPSS) was used. Descriptive statistics allowed us to describe and summarize the data obtained which were compared using the chi-square (X2) and Fisher's exact test. The statistical significance level adopted was 5% (p

Improving the quality of life for multiple sclerosis patients using the nurse-based home visiting model

Multiple sclerosis (MS) sufferers have a high prevalence of co-morbidity associated with poor quality of life, high health care costs and increased risk for adverse outcomes. These patients are often lacking in optimal home care, which may result in subsequent hospital readmissions. However, a specific nurse-based home visiting model for patients with MS is not yet available in Turkey. The aim of this study was to determine the effects of nursing interventions according to The North American Nursing Diagnosis Association (NANDA). Using the NANDA guidelines, the aim of this study was to determine the effect of home visit nursing interventions on the many challenges and quality-of-life (QOL) issues faced by patients with MS. This study used a pretest-posttest experimental group design. The study sample of 45 patients with MS, who had previously registered with the MS Society, had 21 participants in the intervention group and 24 in the control group. Data were collected with the 'General Questionnaire Form' and 'Symptom Evaluation Form' and 'Multiple Sclerosis Quality-of-Life Scale' (MSQOL-54). The NANDA classification system of care plans for conducting eight home visits with the intervention group was also used. Our intervention would identify symptoms, give training, consulting and care services and be able to recognize when referrals to other medical professionals might be necessary. The control group would receive the usual care with just two visits. There was a statistically significant difference between the intervention and control groups regarding the MSQOL-54P score change (p = 0.02), but a nonsignificant difference for the MSQOL-54M. This model helped to achieve an improvement trend in the QOL scores of the MS patient intervention group. This home visit model can also be used to increase the quality of care and quality of life for patients with MS.

Case Study: A Young Male With Auditory Hallucinations in Paranoid Schizophrenia

PURPOSE. The purpose of this case study is to demonstrate use of the nursing process and the standardized nursing languages of NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a young male with paranoid schizophrenia to deal with auditory hallucinations.DATA SOURCES. Data were obtained from the experience and expertise of the author and published literature.DATA SYNTHESIS. This case study demonstrates nurses' clinical decision making in providing care for an adolescent with mental illness.CONCLUSION. This case study provides the pertinent nursing diagnosis, patient outcomes, and nursing interventions for a young male with auditory hallucinations in paranoid schizophrenia.IMPLICATIONS FOR NURSING. The use of NANDA‐I, NOC, and NIC can provide the necessary framework for enhancing and improving the management of care with patients who experience auditory hallucinations in paranoid schizophrenia.

Assistência de enfermagem no pós-operatório de transplante hepático: identificando diagnósticos de enfermagem

Documentary research conducted in a hospital in Fortaleza, Ceara State from January to April 2008 that aimed to identify the nursing diagnosis in the post-operative period of patients undergoing liver transplantation. Out of 14 files, it was investigated the charts of all patients transplanted during the investigation by means of a form, from the medical notes and nursing in the first 24 hours after surgery. It was identified 21 nursing diagnoses according to Taxonomy II of the North American Nursing Diagnosis Association (NANDA). Nine (43%) diagnoses were present in all patients: risk of infection, inefficient protection, ineffective tissue integrity, and risk for perioperative positioning injury, lack of self-care for bath / hygiene, impaired verbal communication, unbalanced nutrition, risk of aspiration and impaired bed mobility. In addition, other 12 (57%) less frequent diagnoses were identified. The nursing diagnosis becomes a facilitator of nursing actions, because it indicates which interventions meets the clinical needs of patients, using the critical evaluation for decision making. It is concluded that nursing diagnoses are essential for the construction of a holistic, humanized and personal treatment plan, providing subsidies to improve the perioperative practice of liver transplantation.

Enfoque biopsicosocial en una intervención multidisciplinar: a propósito de un caso de maternidad de una pareja con discapacidad psíquica

A case report is presented of a newborn who was seen by the paediatric nurse a Primary Care clinic, and whose parents had mental disabilities. They had been followed up for years by the social services in their area, due to difficulties and limitations in their personal, social and employment development. They were also living in unhealthy conditions, so in order to address the problem, a multidisciplinary team of professionals from different areas was formed. We prepared a standardised care plan based on the model of the basic needs of Virginia Henderson. Using taxonomies of the North American Nursing Diagnosis Association (NANDA), Nursing Outcomes Classification's (NOC) and Nursing Interventions Classification (NIC) "knowledge poor" and "parental impairment" diagnoses were made. The nursing and social work goals were to make an assessment, support and use comprehensive biopsychosocial family monitoring to enable the child to grow and develop in the best possible conditions, to monitor child protection and try to improve the living conditions of the home. The child and parents were initially monitored weekly and then monthly. The assessment showed an improvement in care: "background: infant care," "risk control: drug abuse" "child care: psychological security" and "execution of the role of parents." The joint and coordinated work of the various services involved was focused towards achieving the goals set, in order to give biopsychosocial care to the baby and family.

모바일 응용 기반 간호과정 교육 프로그램 개발

본 연구는 간호사 및 간호학생을 위한 간호진단, 간호중재, 간호결과 분류체계의 간호과정 프로그램을 모바일 응용 기반으로 개발하였다. 연구재료는 표준화된 분류체계인 북미간호진단협의회의 간호진단 분류체계와 아이오와 대학을 중심으로 개발된 간호중재 분류체계, 간호결과 분류체계를 사용하였다. 기존 연구 방법은 간호과정의 일부분만을 선택하여 개발하므로 환경에 제한적인 프로그램으로 임상에 일반화시켜 환자들에게 적용하기 어려웠다. 그러나 본 연구는 진단-결과-중재의 전체를 연계시킨 프레임워크를 개발하므로 어떠한 임상환경에서도 적용이 가능한 가이드라인으로 개발하였다. 개발된 프로그램은 한글판으로 3월부터 앱 스토어에 등록되었으며 간호교육 도구로 적극적으로 활용되기를 기대한다. The purpose of this research paper is to develop Mobile application-based Nursing Process Programs on 'Nursing Diagnosis', 'Nursing Interventions' and 'Nursing Outcomes Classification' targeting nurses and nurse students. To achieve it, this paper uses 'standard classification-focused research data' on the basis of Nursing Diagnosis Classification established by NANDA (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification) mainly developed by Iowa State University. The existing research methods are difficult to be applied to patients, since such methods put a restriction on choosing, developing, and generalizing 'Nursing Process Programs' in clinical spheres. But, this research thesis focuses on developing guidelines applicable to any clinical experiences, with the use of the framework in mutual links with all the nursing diagnosisoutcomes- interventions. In this regard, the Korean version programs were developed and registered in App store in March. Thus, it is expected that these programs would be wildly-available as tools for nursing education.

Seguimiento domiciliario de una paciente con diabetes mellitus complicada entre la gestora de casos y la enfermera comunitaria II

This is a continuation of the article published in this journal ( Enfermeria Clinica), entitled “Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home”. We present the case of a 76 year- old patient with long-term and clinically complex Diabetes Mellitus. The patient was taking part in the Primary Care home care program. This article describes the follow-up of the case in which new complications appeared in the right limb, which led to the amputation of the second limb. A new evaluation following Virginia's Henderson model was performed six months after the initial care plan. Nursing diagnoses were made following the North American Nursing Diagnosis Association (NANDA). These diagnoses led to changes in objectives and performance criteria using, nursing outcomes classification (NOC) and nursing interventions classification (NIC). One of the results obtained was the improvement of her well-being by enabling the patient to interact and integrate socially within her environment after mobilising the corresponding social and family resources.Involvement in clinical practice is important in the prevention of diabetes mellitus and diabetic foot complications. Difficult and complex situations are sometimes beyond the ability of the community nurse. It can be beneficial to take advantage of the clinical support offered by the case management model and the integrated approach of a multidisciplinary team.

Older Adult Who Falls: A Case Study

The purpose of this case study is to illustrate the nursing process by incorporating the standardized nursing languages of NANDA International, the Nursing Interventions Classification, and the Nursing Outcomes Classification to assist an older adult with a history of falls. The data sources were the author's clinical nursing practice and research-based evidence related to falls of older adults. The data were synthesized by using clinical reasoning to select the best possible nursing diagnoses, interventions, and patient outcomes. To provide a framework for nurses to achieve positive patient outcomes, standardized nursing languages should be incorporated into patients' clinical nursing databases. In determining factors that relate to falls, nurses need to obtain baseline data, set goals with patients, and identify milestones, while encouraging patients to be active participants in plans of care.

Nursing Diagnoses, Interventions, and Patient Outcomes for Hospitalized Older Adults with Pneumonia

A study was conducted by academic and community hospital partners with clinical information systems that included the standardized nursing language classifications of the North American Nursing Diagnosis Association International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). The aim of the study was to determine the frequency of NANDA-I, NIC, and NOC (NNN) terms documented for older adults with pneumonia who were discharged from three hospitals during a 1-year period. NNN terms were ranked according to frequency for each hospital, and then the rankings were compared with previous studies. Similarity was greater across hospitals in rankings of NANDA-I and NOC terms than in rankings of NIC terms. NANDA-I and NIC terms are influenced by reimbursement and regulatory factors as well as patient condition. The 10 most frequent NNN terms for each hospital accounted only for a small to moderate percentage of the terms selected.

Diagnósticos enfermeros en UFISS, UGA, traumatología y CIR

In 2006, after the addition of a new nurse in UFISS (Social-Sanitary Functional Interdisciplinary Unit), is detected the need of a common language for all nurses with which to conduct a data collection for the nursing reports. The aim of this study is to know the main nursing diagnoses in UFISS, Geriatrics, Traumatology and Surgery units, using the NANDA (North American Nursing Diagnosis Association) nursing diagnostic terminology. We performed a retrospective study of all the medical reports at UFISS in 2006, a prospective study of all medical reports at Geriatrics and geriatric patients at Traumatology and Surgery in various periods between 2008 and 2009. According to the results, the use of a validated method like NANDA diagnoses, has enabled to nurses to identify common altered needs and after that, to define Nursing Diagnoses and develop the optimal care plan for the patient

Supporting Breast-feeding When a Woman Is Homeless

This case study demonstrates use of standardized nursing languages in the care of new mothers in community settings. The author collected data from clinical practice as an instructor in a baccalaureate nursing program and from the research literature. The appropriate nursing diagnoses, outcomes, and interventions were identified in partnership with the new mother. This case shows that NANDA International (NANDA-I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) are useful to direct nursing care in community settings. When teaching nursing students in a baccalaureate program, nurse faculty can use NANDA-I, NOC, and NIC classifications to guide the growing practice of nursing students in community settings.