Nursing Care Model Research Articles

National Estimates of Workplace Telehealth Use Among Emergency Nurses and All Registered Nurses in the United States

IntroductionThe goal of this research was to quantify the baseline status of prepandemic workplace emergency nursing telehealth as a key consideration for ongoing telehealth growth and sustainable emergency nursing care model planning. The purpose of this research was to: (1) generate national estimates of prepandemic workplace telehealth use among emergency and other inpatient hospital nurses and (2) map the geographic distribution of prepandemic workplace emergency nurse telehealth use by state of nurse residence. MethodsWe generated national estimates using data from the 2018 National Sample Survey of Registered Nurses. Data were analyzed using jack-knife estimation procedures coherent with the complex sampling design selected as representative of the population and requiring analysis with survey weights. ResultsWeighted estimates of the 161 865 emergency nurses, compared with 1 191 287 other inpatient nurses revealed more reported telehealth in the workplace setting (49% vs 34%) and individual clinical practice telehealth use (36% vs 15%) among emergency nurses. The geographic distribution of individual clinical practice emergency nurse telehealth use indicates greatest adoption per 10 000 state residents in Maine, Alaska, and Missouri with more states in the Midwest demonstrating emergency nurse adoption of telehealth into clinical practice per population than other regions in the United States. DiscussionBy quantifying prepandemic national telehealth use, the results provide corroborating evidence to the potential long-term adoptability and sustainability of telenursing in the emergency nursing specialty. The results also implicate the need to proactively define emergency nursing telehealth care model standards of practice, nurse competencies, and reimbursement.

Exploring hospital compliance with the primary nursing care model: validating an inventory using the Delphi method

BackgroundThe primary nursing care model is considered a personalized model of care delivery based on care continuity and on the relationship between the nurse and patient. Primary nursing checklists are not often mentioned in the literature; however, they represent a valid instrument to develop, implement, and evaluate primary nursing. The aim of this study was to create a structured checklist to explore hospital compliance in primary nursing.MethodsThe Delphi method was used to develop and validate a checklist. The preliminary version was created and sent to three experts for their opinions. Their comments were ultimately used in the first version, which included four components with 19 items regarding primary nursing characteristics. A two-round Delphi process was used to generate consensus items. The Delphi panel consisted of six experts working in primary nursing contexts and/or teaching or studying primary nursing. Data were collected using a structured questionnaire from July 2020 to January 2021. These experts were asked to rate each element for relevance using a 4-point Likert-type scale. Furthermore, the consensus among the panel of experts was set at ≥78%, with selected items being voted “quite relevant” and “highly relevant”. Content validity index (I-CVI) and modified kappa statistic were also calculated. Following expert evaluation, the first version of the checklist was modified, and the new version, constituting 17 items, was sent to the same experts.ResultsThe first version of the checklist demonstrated a main relevance score of 3.34 (SD = 0.83; range = 1.3–4; mean I-CVI = 0.84; range: 0.83–1), but three items did not receive an adequate I-CVI score, that is, lower than 0.78. After the second round, the I-CVIs improved. The main score of relevance was 3.61 (SD: 0.35; range = 2.83–4; mean = I-CVI: 0.93). The S-CVI/UA was 0.58, and the S-CVI/Ave was 0.93.ConclusionMeasuring primary nursing compliance should be implemented to provide continuous feedback to nurses. Moreover, utilizing valid checklists could permit comparing different results from others’ research. Future research should be conducted to compare the results from the checklist with nursing outcomes.

Effect of Humanistic Nursing Care on Relieving Generalized Pain and Negative Emotions in Patients with Advanced Liver Cancer Complicated with Respiratory Failure

To investigate the effect of humanistic nursing care on relieving generalized pain and negative emotions in patients with advanced liver cancer complicated with respiratory failure. 80 patients with advanced liver cancer complicated with respiratory failure who were admitted to the oncology department of our hospital (November 2018-November 2019) were chosen as the study subjects and split into group X (n=40) and group Y (n=40), according to method of coin tossing. Among them, group Y received clinical routine nursing care, while group X received humanistic nursing care based on the nursing care in group Y; after that, the effect of these two nursing care models on generalized pain and negative emotions in patients was compared. No obvious difference in sex ratio, age, smoking history, drinking history, Child-Pugh classification of liver function, tumor morphotype and place of residence was found between the two groups (P < 0.05). With no obvious differences in HAMA and HAMD scores between the two groups before nursing care (P > 0.05), HAMA and HAMD scores in group X after nursing care were obviously lower compared with group Y (P < 0.001). The VAS scores of the patients in both groups after nursing care were obviously lower (P < 0.001), VAS scores in group X after nursing care were obviously lower compared with group Y (P < 0.001). With no significant differences in quality of life and PSQI scores between the two groups before nursing care (P > 0.05), quality of life and PSQI scores in group X after nursing care were obviously better compared with group Y (P < 0.001). The scores of optimism, self-reliance and tenacity of the patients in both groups after nursing care were obviously higher (P < 0.05), and scores of optimism, self-reliance and tenacity of the patients in group X were obviously higher compared with group Y (P < 0.05). The total nursing satisfaction in group X was obviously higher compared with group Y (P < 0.05). Humanistic nursing care can effectively relieve generalized pain and improve negative emotions as well as life quality in patients with advanced liver cancer complicated with respiratory failure, with significant therapeutic effect, which is worthy of application and popularization in clinical nursing.

ECMO During a Pandemic: A COVID-19 Quality Improvement Process.

Extracorporeal membrane oxygenation is a modified form of cardiopulmonary bypass and a complex adult critical care therapy. No evidence appears to exist on sustaining relevant quality nursing standards during a pandemic. The aim for this quality improvement process was to address nursing provision in real time related to extracorporeal membrane oxygenation in a pandemic, providing fundamentals for future readiness. The Ishikawa fishbone diagram and a Plan-Do-Study-Act cycle were methods used. Process changes included implementation of a communication algorithm, an alternative nursing care model, increased nursing staffing and leadership visibility, use of perfusion services for nursing task support, and minimized nursing documentation. Changes applied were successful. We recommend increasing nursing staffing volume and support resources, applying a communication algorithm, and minimizing documentation requirements. These strategies are generalizable to other clinical nursing areas in similar pandemics or disasters.

Effects of a continuous nursing care model on elderly patients with total hip arthroplasty: a randomized controlled trial.

Continuous nursing care (CNC) is an extended service based on meeting the needs of discharged patients for post-discharge treatment and rehabilitation. This research aimed to investigate the effects of CNC on older patients with total hip arthroplasty and to offer a scientific basis for improving the prognosis. A total of 134 patients with total hip arthroplasty were randomly divided into the control group (n = 67) and the intervention group (n = 67). The control group was treated by conventional nursing care and the intervention group was treated by CNC. Harris hip score, Barthel index, the activities of daily living (ADL) scale, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) in these two groups were evaluated. Demographic characteristics between groups were analyzed by unpaired t test. The observation indexes between groups were assessed by two-way ANOVA test followed by Tukey's multiple comparisons test. The scores of Harris hip score, Barthel index, ADL, SDS and SAS in the intervention group after intervention and after follow-up were better than the intervention group before intervention (all p < 0.01). Meanwhile, the scores of Harris hip score, Barthel index, ADL, SDS and SAS in the intervention group were better than the control group both after intervention and after follow-up (all p < 0.01). In conclusion, CNC showed better efficacy than conventional nursing care in promoting hip joint function recovery, improving quality of life and alleviating anxiety and depression for older patients with total hip arthroplasty.

An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19.

BackgroundDuring the COVID‐19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis.PurposeTo review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes.MethodsWe conducted an integrative review of team nursing and delegation using Whittemore and Knafl’s (2005) methodology.ResultsWe identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses’ delegation knowledge, decision‐making, and competency.Linking evidence to actionTeam nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.

PERCEPTION OF NURSING STAFF TOWARD THE APPLICATION OF PROFESSIONAL NURSING CARE MODEL (MAKP) AND JOB SATISFACTION IN GOVERNMENT HOSPITALS LAHORE

Purpose: Nursing care delivery is a provision of nursing care in the hospital because the nurse has 24-hour interaction with the patient. PROFESSIONAL NURSING CARE MODEL or in Indonesian language is (MAKP). The aim of this study is to evaluate the perception of nursing staff toward the application of professional nursing care model and job satisfaction. Evaluate the nurses’ perception toward the implication of nursing care model (MAKP) and job satisfaction. Methodology: A cross sectional study was conducted in government hospital of Pakistan from February 2021 to April 2021. Sample size was 134 and sampling was conducted via simple random sampling by distributing questionnaire. Data was analyze by using the SPSS version 21. Findings: All the participants are female. It was revealed that the nurses have sufficient knowledge about the 5 components of MAKP model and there is no relation between application of nursing care model (MAKP) with job satisfaction. Unique Contribution to Theory, Practice and Policy: The nurses have sufficient knowledge about the 5 component of professional nursing care model and the job satisfaction has no association with the application of nursing care model except of delegation, co-ordination and leader.

Applying the Synergy Model to inform the nursing model of care in an inpatient and an ambulatory care setting: The experience of two urban cancer institutions, Hamilton Health Sciences and Grand River Regional Cancer Centre.

The incidence and prevalence of cancer continues to rise throughout Canada. Approximately one in two Canadians are expected to develop cancer at some point in their lives (Canadian Cancer Society, 2021). As the complexity and acuity of individuals with cancer increases, there is increased necessity to define the ideal nurse-to-patient ratio and patient caseload for nurses in specialized oncology settings. Two senior nurse leaders, faced with the need to determine the most appropriate model to inform the nursing model of care within their respective care areas, collaborated and decided to implement the Synergy Model. The Synergy Model is a professional practice model developed by the American Association of Critical Care Nurses (AACN). In the Synergy Model, nursing care reflects the integration of nurses' knowledge, skills, attitudes, competencies, and experience to meet the needs of patients and families (Curley, 2007). This model provides a framework for matching nursing resources based on patient care needs and has been adapted in various care settings. The model, however, has not been applied in a surgical oncology inpatient unit or in an oncology ambulatory care setting. Using a quality improvement methodology, the Synergy Model was piloted in these new areas and found to be effective. The Synergy Model can be utilized to determine the need for additional nursing resources with specialized oncology nurses and appropriate skill mix of intraprofessional nursing teams. It can also be used to assess adult oncology patients who present to the ambulatory systemic care suite for unscheduled care related to symptomatic concerns.

A study protocol to evaluate the implementation and effectiveness of the Clinical Nurse Leader Care Model in improving quality and safety outcomes.

AimsPatients are harmed or die every year because of unsafe, inappropriate or inadequate healthcare delivery. Registered Nurses are a recognized patient safety strategy. However, variability in research findings indicate the relationship is not as simple as “more nurses=better outcomes.” Hence, currently there exists no evidence‐based frontline nursing care model. One emerging model is the Clinical Nurse Leader care model.DesignThis Hybrid Type II Implementation‐Effectiveness study will evaluate the effect of the care model on standardized quality and safety outcomes and identify implementation characteristics that are sufficient and necessary to achieve outcomes.MethodsThis study leverages a natural experiment in 66 clinical care units in nine hospitals across five states in the United States that have implemented the Clinical Nurse Leader care model.ResultsFindings will elucidate Registered Nurse's mechanisms of action as organized into frontline models of care and link actions to improved care quality and safety.

PATIENTS 'PREFERENCES AND EXPERIENCES IN CHOOSING THE MODEL OF NORMAL LABOR CARE

AbstractBackground: In the last few decades the trend of work has shifted from normal delivery to Sectio Caesarea (SC), this is evidenced by the increasing incidence of CS deliveries in various countries. cesarean delivery without medical indications is one of the biggest factors causing cesarean delivery, this is due to the fear of normal labor pain. However, in developing countries, women still see a lot of interest in being able to be born normally, so the purpose of this study is to find out preferences and research experiences in choosing a normal delivery care model. Methods: The method used is a qualitative research by exploring, with the population is postpartum mothers who are in the target area of the Tuban Public Health Center and the Semanding Health Center, Tuban, East Java. The total respondents in this study were 8 respondents, the results of interviews with 8 respondents were then analyzed by transcribing verbatim, making general points, noting ideas that arise, and indexing or coding. Results: 1) preference for places of occurrence, geographical and economic factors, 2) preference in choosing a model that is carried out by a fast recovery process, and feeling like a real mother. 3) The preference for stress helpers is influenced by experiences from other families. Conclusion Preferences for nursing care models can affect the mother's decision making in choosing a nursing care model that can have an impact on her delivery experience

Implementing Nursing round to Deal with Unresolved Nursing Problem on Patient with Acute Pain: A Case Report

Background: The determining factors for improvement of health services quality includes nursing services. Furthermore, a method for providing this quality nursing services is professional nursing care model, and comprises nursing round. However, fewer hospitals implement this due to several barriers including lack of knowledge and practices. This study is, therefore, aimed at identifying improvements in quality of nursing care and solving of patient’s problem by frequent nursing rounds.Design and Method: This study employed a single case report design using exploratory and descriptive methods. A 27-year-old male underwent nephrectomy surgery to treat hydronephrosis. The person still revealed persistent pain in the surgery area even though it has been treated for 3 days. The staff nurses administered nursing round to discuss and solve this problem. The study participation was voluntary, while the involved patient gave the informed consent. The steps of nursing round procedure including preround, round, and post-round were used to solve the problem.Results: The results indicated that nurses discovered blood clots in the patient’s drain during nursing round. The cause of the persistent pain was revealed and used to determine the intervention modification needed. It was recommended to evacuate the blood clot and followed by appropriate pain management. Furthermore, the problem in the patient with acute pain was resolved.Results: The results indicated that nurses discovered blood clots in the patient’s drain during nursing round. The cause of the persistent pain was revealed and used to determine the intervention modification needed. It was recommended to evacuate the blood clot and followed by appropriate pain management. Furthermore, the problem in the patient with acute pain was resolved.Significance for public healthThe presence of nursing rounds positively impacted patient satisfaction, and has the potential to improve patient-nurse interactions and promote the quality of care. Furthermore, nursing round is a structured intervention providing nurses with the opportunity to identify and solve patient’s needs and problems respectively. The findings on specific related problems are useful to support the evidence provided with regards to the possible benefits. This facilitates improved nurses decision-making abilities based on clinical observations and patient-centered care.

Impact of Coronary Artery Bypass Graft on Activities of Daily Living of Patients With Coronary Artery Disease

Background: When it comes to a major surgery such as Coronary Artery Bypass Graft (CABG), functional independence is the ultimate goal of treatment over mere survival or drastic reduction in the risk of the life-threatening event caused due to Coronary Artery Diseases (CAD). Objective: To find the difference in the ability to perform Activities of Daily Living (ADL) before and after the CABG between control and study groups who received conventional methods and who received nursing care by using the Extended Nursing Care Model (ENCM), respectively. Materials and Methods: Data were obtained from 132 patients before CABG and after six weeks and three months of CABG. Patients were enrolled on the day before surgery and included those who were discharged only within seven days of surgery. The lottery method was used on a weekly basis for allocation of the patients in the control and study groups. The study group’s recovery was managed by using ENCM, and the control group’s recovery was managed by using the conventional method. Functional independence in performing ADL was measured by using a standardized Barthel scale. Data were also collected on developing independence in performing the bathing activity. Results: The majority of patients’ mobility-walking and staircase use activities were affected before CABG. The mean score of the functional independence has improved from baseline to six weeks and three months in both the groups. The difference in the functional independence score between the two groups was tested by using the Mann-Whitney’s sign-rank test. The improvement was found to be better in the study group than the control group at a 5% significance level at six weeks and three months after CABG. Conclusion: The researcher concludes that though functional independence is compromised in the initial stage of recovery of CABG, it improves over some time and this improvement can accelerate with the use of interventions in the ENCM.

Effects of Online Home Nursing Care Model Application on Patients with Traumatic Spinal Cord Injury.

ObjectiveThis study aims to explore the effects of an online home nursing care model application on patients with traumatic spinal cord injury (TSCI).MethodsEighty patients with TSCI discharged from the hospital between January 2015 and January 2018 were included in the study. The patients were randomly divided into two groups: the control group and the observation group (n = 40, each). The patients in the control group were given routine discharge guidance, while the patients in the observation group were given online home nursing care. The Oswestry Disability Index (ODI), Medical Outcomes Study 36-item short-form health survey (MOS SF-36), and complication-incidence rate were used to evaluate the efficiency of the online home nursing care model.ResultsThere were no differences in the ODI and MOS SF-36 scores between the two groups at discharge. However, the ODI and MOS SF-36 scores in the observation group showed significant improvement compared with the control group (p < 0.05) during the most recent follow-up. The incidence of complications, such as constipation, joint stiffness, muscle atrophy, foot drop, and pressure sores, were significantly lower in the observation group than in the control group (p < 0.05).ConclusionThe online home nursing care model can reduce complication incidence, alleviate dysfunction, and improve the quality of life of patients with TSCI.

A retrospective study examining the adverse effect of childhood abuse among adult psychiatric service users in Britain.

The long-term effects of childhood abuse have been well studied though the effects of abuse of specific types in adult psychiatric service users are less known. This study aimed to assess the association between childhood abuse and the development of harmful social and behavioural outcomes among adult psychiatric service users. Adult psychiatric service users were accessed from secondary mental health services in South London. A retrospective analysis was conducted of a randomly selected sample of 342 mental health records. Chi-square tests and logistic regression models were used to examine associations between childhood abuse - sexual abuse, physical abuse and psychological/emotional abuse - and health and behavioural outcomes. This study identified that 109 (31.8%) psychiatric service users had some history of childhood abuse and more often presented with high-risk or severe behaviours. Sexual abuse in childhood was linked with social isolation related to loss of friends (odds ratio (OR)=2.68, P<0.01), risky behaviours such as binge drinking (OR=2.15, P<0.05) and self-harming (OR=2.86, P<0.01), while childhood physical abuse was associated with drug abuse in adulthood (OR=1.88, P<0.05). Revictimization (adult domestic violence) also impacted on service users' quality of life in terms of loss of housing (OR=2.21, P<0.05) and loss of friends/family contact (OR=2.73, P<0.01). These findings suggest childhood abuse may play an important role in shaping risk and vulnerability for mental health problems across a lifespan. In acute mental health services, the incorporation of a trauma-informed nursing care model is necessary to generate a shift in culture in the delivery of care.

Implementation of advanced practice nursing for minor orthopedic injuries in the emergency care context: A non-inferiority study

AimsTo evaluate the implementation of advanced practice nursing for patients with minor orthopedic injuries, including comparison of outcomes in relation to advanced practice nurse versus standard (physician-led) care models. DesignA non-inferiority study was performed in an emergency department in Norway, where advanced practice nursing is in an initial stage of implementation. The non-inferiority design was chosen to test whether the new advanced practice nursing model does not compromise quality of care compared to the standard care model already in use. MethodsPatients with minor orthopedic injuries were assessed and treated by either advanced practice nursing or standard (physician-led) care models. Participating patients were assigned to the professional available at presentation. In the nursing model, registered nurses worked at an advanced level/applied advanced practice nursing following in-house-training. Senior orthopedic specialists evaluated the diagnostic and treatment accuracy in both models. Data were collected in a tool developed for this study, from May to October 2019. ResultsIn total, 335 cases were included, of which 167 (49.9%) were assessed and treated in the nursing model. Overall, correct diagnosis was found in 97.3% (n = 326) of the cases, and correct treatment was found in 91.3% (n = 306) of the cases. In comparison of missed diagnosis between advanced practice nurse and the standard (physician-led) care model showed inconclusive results (risk ratio: 0.29, 95% CI: 0.06–1.36). In comparison of treatment outcomes, the results showed that the advanced practice nursing model was non-inferior (risk ratio: 0.45, 95% CI: 0.21–0.97). ConclusionAdvanced practice nursing care models can be used to diagnose and treat minor orthopedic injuries without compromising quality of care. Further implementation of the advanced practice nurse care model is encouraged.

Gender impact of caring on the health of caregivers of persons with dementia

BackgroundDementia is a brain syndrome that affects a growing number of persons worldwide and generates a strong and progressive demand for care from a family caregiver, usually females. ObjectiveWe aimed to describe the care provided by family caregivers of persons with dementia as well as the impact on their health and its interrelation with gender. Patient involvementThis study was carried out in collaboration with the 13 associations of family caregivers of persons with dementia that are part of a Regional Federation. This partnership worked towards bettering patient care and proposing improvements to the public health system. MethodsA multi-institutional cross-sectional study. A total of 462 primary family caregivers of persons with dementia from north-west Spain were included. Data were collected between January and April 2019 with an anonymous self-administered validated questionnaire (ICUB-97) based on Virginia Henderson’s nursing care model. ResultsThe most affected needs in family caregivers are those related to “recreational activities”, “communication” and “rest and sleep”. Statistically significant differences between male and female participants’ pattern of care and health-related impacts were found, especially in issues related to work and family reconciliation. DiscussionCare plans should be developed taking gender perspective into account. From a nurse model point of view, more research is necessary to reduce health disparities. This study provides an assessment of gender differences in care and the impact on caregivers’ health. Practical valueRegarding the specific health conditions of female caregivers and from a holistic point of view, these findings could provide novel and interesting data that might help to implement gender perspective in nursing care plans, generally invisible in routine clinical practice.

‘I Accelerate’ model: A grounded theory on conceptual framework of patient experience with nursing care in China

To develop a conceptual framework of patient experience with nursing care. Patient experience includes several aspects of health care delivery that patients value highly when they seek and receive care and is now increasingly used to evaluate the quality of care. Nurses are the backbone of the health care system, and patient experience with nursing care significantly influences the overall patient satisfaction and hospital performance. However, the conceptual framework of patient experience with nursing care is not clear. This grounded theory study employed in-depth interviews with 37 inpatients between March and May 2020. An explanatory theoretical framework of the patient experience with nursing care emerged and was termed the 'I Accelerate' model; 'I Accelerate' stands for information and interpretation, appropriate attitude, close monitoring of progress, continuity of care, education, linking of the medical team, emotional support, responding to requests promptly, admission and discharge coordination, technical skills, and environment management, highlighting professional, emotional and coordinating functions of nurses. This study resulted in a holistic nursing care model based on patients' views, values and preferences. To create a more therapeutic nurse-patient relationship and a more patient-centred health care system, hospital administrators, nursing managers and nursing practitioners should understand what patients desire and expect. Efforts should be made to explore the barriers and facilitators of using patient experience for quality improvement and to further determine how these patient-perceived attributes of nursing care can be rooted in the daily practice through organisational changes, culture shaping and staff education. There should be recognition of the potential need for psychological and emotional support, as well as of the importance of meeting communication and information needs.

Implementation of a dynamic nursing care model during a global pandemic.

Implementation of a dynamic nursing care model during a global pandemic.

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey.

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey.

Neuman Systems Model in perioperative nursing care for adolescents with juvenile idiopathic scoliosis.

To implement the nursing process, based on the Neuman Systems Model and the International Classification of Nursing Practice terminology, in the care of an adolescent who underwent corrective surgery for juvenile idiopathic scoliosis. This is a qualitative study of the type of single case, with triangulation of data collection techniques (formal clinical interview, notes in a field diary and medical record information), developed with a 17-year-old adolescent and indication for corrective surgery. The empirical materials generated with the interviews carried out at admission and at discharge, observation and medical record information were treated with categorical content analysis. The categories of personal condition, anxiety, selfconcept, meaningful people, facilitating health resources, school, free time and leisure were recurrent. Diagnoses were defined with a focus on Anxiety, Knowledge on pain management (control) and Willingness (or readiness) to learn, associating them with the respective nursing interventions. The Model contributed to assess and recognize surgery stressors for the adolescent and to theoretically base the nursing process. The classification allowed systematizing nursing care records, elements of clinical practice, unifying vocabulary and codes.