Nursing Care Plan Research Articles

Opieka nad pacjentem po zabiegu transplantacji serca – studium przypadku

Heart transplantation is a recognized and effective method of treating end-stage heart failure. Complicated heart transplant surgery carries a high surgical risk as well as complications that are dangerous to life and health. Transplantation is a life-saving opportunity for patients who have run out of alternative treatments. According to Poltransplant data, transplantation was performed in Poland in the last year 2021 200 hearts. Patients with heart transplants face many physical and psychological problems every day. The aim of the study: to diagnose and discuss nursing problems occurring in a patient 3.5 years after heart transplantation, to determine the impact of the organ transplantation on the functioning of the individual in everyday life, and to present a care plan and its results, based on the applied nursing activities. Material and methods: The study uses the research method - an individual case study in which research techniques such as interview, observation, analysis of medical records and measurement of vital signs were used. The selected methods made it possible to develop an individual nursing care plan for the research subject - a 50-year-old patient, three and a half years after the transplant. Results: After the interview, observation and analysis of medical records and as a result of the measurements made, the patient was diagnosed with nursing problems, including such as: increased susceptibility to infections that may pose a serious threat to the life and health of the patient caused by the weakening of the immune system by immunosuppression, anxiety and fear related to the risk of rejection of a transplanted organ and mood instability resulting from uncertain health situation and the effects of immunosuppressive drugs, physical limitations related to with previous operations. Conclusions: Despite the passage of time, the patient after heart transplantation still feels the fear of a sudden deterioration of his health, the occurrence of side effects of the implemented treatment, and to the greatest extent his organism rejects the transplanted organ. Educating the patient, caring for it and keeping track of his health condition makes him feel more confident and at ease. The quality of life of the patient after transplantation can be significantly improved thanks to discipline and properly conducted self-care and self-care.

Fatores determinantes da exposição sexual ao HIV em adolescentes luso-brasileiros: uma análise de caminhos*

Abstract Objective: to analyze the direct and indirect effects of determinants of sexual exposure to the human immunodeficiency virus among male adolescents who have sex with men and the implications for nursing care. Method: cross-sectional study carried out with 578 Portuguese and Brazilian adolescents aged 18 and 19. Interrelationships of conjugal status, use of dating apps, practice of chemsex, unawareness, partner credibility, challenging sexual practices and ineffective forms of protection against sexual exposure to the human immunodeficiency virus were evaluated using the Path Analysis technique. Results: significant direct effect on sexual exposure to the human immunodeficiency virus: conjugal status (β=-0.16), use of apps (β=-0.30), challenging sexual practices (β=0.48) and ineffective forms of protection (β=0.35). Indirect paths: partner credibility influenced ineffective forms of protection (β=0.77); having a steady/polyamorous relationship influenced the use of dating apps (β=-0.46); chemsex, mediated by challenging sexual practices (β=0.67), determined greater sexual exposure. Conclusion: adolescent sexual behaviors and forms of amorous/sexual relationship must be considered in nursing care planning to reduce sexual exposure to the human immunodeficiency virus.

Modification of cognitive behavior therapy to improve the skill of elderly with osteoarthritis

One of the characteristics of physical changes in the elderly involves a decrease in the musculoskeletal system, such as the depletion of the synovial joint fluid which has an impact on the pain felt in joints. This condition can cause a disruption of the quality of life for the elderly and results in increases in the family burden. The purpose of cognitive-behavioral therapy in nurse care planning is to provide an overview of the implementation of family care nursing, community care health nursing, and management of health services by community health nurses to the elderly with osteoarthritis. The innovation and development of this senior citizen community program, initially named Lansia SMART (SMART Elderly), consists of six sessions, including psychoeducation sessions, cognitive restructuring sessions, pain management sessions with progressive muscle relaxation, activity scheduling sessions, problem-solving sessions, and tutorial sessions for the Lansia SMART (SMART Elderly) group with the Android application. The final maintaining challenging stage of these services involved 59 elderly participants. Data analysis used paired T-tests. The results of this innovation showed significant differences in the behavior of the elderly participants after the implementation of the SMART Elderly program (p < 0.05). The SMART Elderly program was effective to improve the elderly participants’ behavior. Nurses can use cognitive behavioral therapy to improve the process of self-management of osteoarthritis among their clients.

The Clinical Effectiveness of Virtual Nursing Process Education During the COVID-19 Pandemic: An Educational Evaluation and a Quasi-experimental Longitudinal Study

Background: The COVID-19 pandemic has changed the mode of education, causing universities to shift from face-to-face to online delivery mode for offering various courses and programs. Thus, it is essential to focus on the curriculum content to tackle the challenges caused by the COVID-19 pandemic and provide methods to effectively educate nursing students in nursing practice. Objectives: This study aimed to determine the clinical effectiveness of virtual nursing process (NP) education in undergraduate nursing students during the COVID-19 pandemic. Methods: This educational evaluation study with a quasi-experimental longitudinal design was applied in four educational steps over six months for first-year undergraduate nursing students (n = 30) using Iran's national learning virtual environment. Results: The paired t-test results showed a significant difference in the mean and overall scores of nursing diagnosis and nursing outcomes/goals before and after the virtual intervention (P < 0.001). Six months after virtual education, the students registered for the ‘clinical nursing process (CNP) unit in the third semester. In the final step of the study, the overall mean score of the students' nursing care plan was 16.59 ± 2.31, which was higher than the mean score, meaning virtual NP education was effective in a clinical setting. Conclusions: Virtual mode of teaching can be effective for theoretical and CNP education.

Applying the theory of human development by Erik and Joan Erikson when communicating with persons with advanced dementia diseases

Persons with advanced dementia disease (ADD), here labelled PADDs, are shown to preserve parts of their self, which has opened up possibilities for involving them in their own care and establishing strategies for improving their communication with the surrounding world. Using the well-known theory of human development proposed by Erik and Joan Erikson, here labelled EJET, can operate as an efficient structure for formal caregivers to support PADDs in reclaiming their space. However, very few studies have used EJET as a framework in improving formal caregivers’ competence and the quality of care. This article aims to demonstrate the feasibility of applying EJET in the care of PADDs through two examples of successful application of this framework in interacting with PADDs in residential care settings. The examples demonstrate the significance of competent caregivers and the important role of tailoring nursing care plans to specific situations of the PADDs in their present and previous developmental phases.

Improving Completeness of Surgical Inpatient Medical Records in Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Introduction One of the most essential steps in improving the quality of service delivery in the health service is the improvement of patients’ medical record completeness. The aim of this study is to assess patient medical record completeness in the Saint Paul hospital department of surgery and assess the pattern of improvement in record completeness after intervention. Methods surgical Patient charts were randomly reviewed with a standard patient chart completeness evaluation checklist prepared by the Federal Ministry of Health. Baseline data was collected in June 2019 and post intervention data was collected in November 2019. The schedule for intervention was carried out between July and October 2019. Interventions include modification of formats, continuous monitoring, and inclusion of chart completeness in the monthly morbidity and mortality conference, and establishment of a recognition system for best performing wards. Result A total of 253 and 273 medical charts were evaluated during baseline and post intervention. The Post intervention assessment showed 206 (75.5%) of records had admission notes completed, 205 (75%), the order sheet was completed in 218 (79.7%) and the discharge summary was completed in 217 (79.5%) of medical records. From nursing parameters, the medication sheet was completed in 177 (64.8%) and the nursing care plan was completed in 155 (56.8%) of medical records. When all six indicators were seen in aggregate, total medical record completeness showed a statistically significant improvement from 41% during base line to 72% post intervention (p < 0.05). Conclusion and recommendation Study has shown that small and persistent quality improvement interventions that focus on continuous evaluation, leadership engagement, and innovative strategies bring significant improvement in record completeness.

Nursing diagnoses among oncology patients in medical units: a retrospective study of patients' records.

ObjectiveNursing care plans for oncology patients are complex and overlapping enough to warrant the need for systematised documentation that ensures high quality, flawless and comprehensive care. Addressing the patients’ needs through nursing diagnoses is the initial step that shapes the subsequent care. Therefore, the current study aimed to identify the frequent NANDA-I diagnoses reported in nursing care plans for medical oncology patients.Data sourcesA retrospective design was used to collect data from 260 electronic nursing care records of oncology patients admitted to medical floors at an accredited oncology centre in Jordan.ConclusionThe complexity of nursing care for oncology patients can be inferred from the high number of reported nursing diagnoses. This study summarises the most common nursing diagnoses and their combinations that can be used as a guide to formulate nursing care plans for oncology patients in medical units.Implications for nursing practiceOncology nurses may refer to this study to guide and support their care and documentations to maintain a high standard of nursing practice. Besides, the reported diagnoses can be integrated to generate pre-printed, standardised nursing care plans, where diagnoses are listed for nurses to select the applicable ones for their patients. Similarly, the combinations of nursing diagnoses may guide nurses to search for a concurrent diagnosis, thus improving patients’ outcomes. This study revealed the complexity of patients’ care in medical oncology units, which alarms the nursing managers to reconsider the nurse–patient ratio in these settings to meet patients’ care demands and maintain their safety.

Optimalisasi program perkesmas dengan kunjungan rumah terhadap tingkat kemandirian keluarga serta peningkatan pengetahuan perawat dalam penulisan askep keluarga

Program Indonesia Sehat Pendekatan Keluarga (PISPK) is necessary to have continuous intervention and become a integrated program at the Public Health Center (Puskesmas). The aim purposes of this activities was to analyzed The desired objectives are to optimize home visits to increase the level of family independence and to optimize the competence of nurses in writing and documentation of family nursing care plan integrated with Nanda, Noc and Nic. The implementation phase includes home visits conducted 2-4 times and carrying out cross-program activities and the evaluation phase includes recompiling and analyzed data. There are 18 heads of households who are respondents. This activity showed that home visits through providing family nursing care and education in the family gave change the family independence level. In the future, it is expected that home visits will become priority of Public Health Center (Puskesmas) activities to improve community health status, In addition, the guidelines and modules are able to increase the knowledge, attitudes, skills, and activities of nurses in the implementation of community health services which increase the use of health facilities by families and as a complement to the community health services module in order to improve the performance of Nurse in Public Health center.

Optimalisasi program perkesmas dengan kunjungan rumah terhadap tingkat kemandirian keluarga serta peningkatan pengetahuan perawat dalam penulisan askep keluarga

Program Indonesia Sehat Pendekatan Keluarga (PISPK) is necessary to have continuous intervention and become a integrated program at the Public Health Center (Puskesmas). The aim purposes of this activities was to analyzed The desired objectives are to optimize home visits to increase the level of family independence and to optimize the competence of nurses in writing and documentation of family nursing care plan integrated with Nanda, Noc and Nic. The implementation phase includes home visits conducted 2-4 times and carrying out cross-program activities and the evaluation phase includes recompiling and analyzed data. There are 18 heads of households who are respondents. This activity showed that home visits through providing family nursing care and education in the family gave change the family independence level. In the future, it is expected that home visits will become priority of Public Health Center (Puskesmas) activities to improve community health status, In addition, the guidelines and modules are able to increase the knowledge, attitudes, skills, and activities of nurses in the implementation of community health services which increase the use of health facilities by families and as a complement to the community health services module in order to improve the performance of Nurse in Public Health center.Â

Evaluating the relationships between multiple symptoms; altered nutritional status, and their effects on the quality of life of patients diagnosed with cancer in Palestine: an explorative study

Background Cancer is the second most fatal disease in the world, following cardiac diseases. Throughout the cancer trajectory, patients experience symptom clusters and malnutrition. Both affect the quality of life for these patients. Limited studies had focused on these issues in Palestine. Purpose This study aims to assess and evaluate the relationships between multiple symptoms, altered nutritional status, and their effects on the quality of life of patients diagnosed with cancer in Palestine. Methods An explorative cross-sectional study was conducted to collect data from 120 patients with cancer. Results Fatigue, dry mouth, and pain were the most prevalent symptoms experienced by participants with mean scores of 5.5, 4.9, and 4.5 respectively. For the quality of life, general activity and work were the worst variables experienced by patients. More than half of the patients were malnourished (53%). Nutritional status was significantly correlated and predicted most of the symptoms and quality of life dimensions (P < 0.05). Conclusion The current study highlighted the importance of symptom clusters in cancer, quality of life, and nutritional status. It also focused on nutritional status as an essential factor and critical predictor that may affect and correlate with the worst symptom clusters and low quality of life. Implication Symptom clusters and malnutrition predict the poor quality of life among Palestinian oncology patients. Therefore, symptom clusters and nutritional status should be taken into consideration at an earlier stage in the nursing care plan, and in the oncology assessment guidelines in Palestine.

Use of machine learning to transform complex standardized nursing care plan data into meaningful research variables: a palliative care exemplar.

The aim of this article was to describe a novel methodology for transforming complex nursing care plan data into meaningful variables to assess the impact of nursing care. We extracted standardized care plan data for older adults from the electronic health records of 4 hospitals. We created a palliative care framework with 8 categories. A subset of the data was manually classified under the framework, which was then used to train random forest machine learning algorithms that performed automated classification. Two expert raters achieved a 78% agreement rate. Random forest classifiers trained using the expert consensus achieved accuracy (agreement with consensus) between 77% and 89%. The best classifier was utilized for the automated classification of the remaining data. Utilizing machine learning reduces the cost of transforming raw data into representative constructs that can be used in research and practice to understand the essence of nursing specialty care, such as palliative care.

Sleep Quality And Fatigue Level Of Patients With Coronary Angiography

Objective: The aim of this study was to determine sleep quality and fatigue levels of patients who underwent angiography in coronary intensive care unit.&#x0D; Methods: This study was performed among individuals who underwent angiography in the coronary intensive unit of a City Hospital in the center of a city in Turkey between December 15, 2018 and April 15, 2019 (n:205). Data were obtained using the Patient Identification Form, Richards-Campbell Sleep Scale, Brief Fatigue Inventory.&#x0D; Results: The mean score of Richard’s Campbell Sleep Scale was 46.01 ± 18.90 in patients undergoing angiography at the coronary intensive care unit. The mean score of the Brief Fatigue Scale was found to be 4.49 ± 1.99. A negative correlation was found between the mean Richard’s Campbell Sleep Scale and Brief Fatigue Inventory and its subdimension scores. The fatigue levels were found to be increased as the sleep quality of the patients decreased.&#x0D; Conclusions: It was determined that patients undergoing coronary angiography had poor sleep quality and high levels of fatigue, and this was caused by several factors. In line with these results, it is recommended to make nursing care plans and consultancy for sleep hygiene and activity planning at regular intervals for individuals at risk.

Care tasks and impact of caring in primary family caregivers: A cross-sectional study from a nursing perspective

BackgroundFamily caregivers of persons with dementia often experience a negative impact on their health. More studies based on nursing theories are needed to improve the provision of care. AimsTo describe the care provided by family caregivers of persons with dementia and the impact on their health, as well as to analyse how personal variables of caregivers are related to care tasks and their health impact. MethodsMulti-centric cross-sectional prospective study conducted on a sample of 423 primary family caregivers of persons with dementia from Spain. Data were collected through ICUB97-R questionnaire (January–April 2019), based on the fourteen needs of Virginia Henderson's Nursing Model. Data was analysed through one-way analysis of variance and Student's t-test. ResultsThe caregiver profile was a middle-aged married woman without higher education living with the cared person, predominantly her mother. The most frequently provided care corresponded to “nutrition” and “movement” needs. Lack of free time, modifications on leisure activities, reduced sleep or rest and disruption of family life emerged as the greatest repercussions on the caregiver's health. The age of the caregiver and time caring showed differences on impact of care and care tasks, respectively. ConclusionThe identification of the types of care provided, the health impact of caring and the variables affecting the family caregiver's vulnerability is essential to develop effective individualised nursing care plans, including health education interventions to improve the quality of life of both caregivers and persons cared for.

Case Report on Tuberculosis Meningitis-A Nurses Perspective

Mycobacterium tuberculosis is the bacteria that cause tuberculosis. If the infection is not treated immediately the bacterium passes via the circulatory system and spread other organs and tissues. Pathogen will travel to the meninges and causes inflammation of membranes called as tubercular meningitis. Here, the authors report a case of tuberculous meningitis a 42- years-old male patient with the chief complaints of low grade fever with chills since 1 month, headache in frontal region since 5-6 days, altered sensorium, breathing difficulty, reduced speech and left side weakness of the body since 1 day. After admitting in the ward all investigation done like MRI brain, ECG, lumbar puncture, blood tests etc. and he diagnosed as tuberculous meningitis. Patient admitted in AVBRH in ICU, investigations done, where patient was on NIV support, nasogastric tube, foleys catheter and it has been removed as patient was improving the condition and shifted in ward. Patient medical treatment in the ward was inj. C-tri 2 gm, Inj.levoflox 500 mg, inj. thimine 100 mg, Inj.Dexamethasone 10 mg, tab. Pan 40 mg, tab. Akt4 3, Inj.manitol, tab. Lorazepam. History collection, Physical examination, neurological assessment and nursing care plan were done after all treatment patient condition has been improved.

Implementation of a Frailty Assessment and Targeted Care Interventions and Its Association with Reduced Postoperative Complications in Elderly Surgical Patients

Older patients with frailty syndrome have a greater risk of poor postoperative outcomes. In this study, we used a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to implement an assessment tool to identify frail patients and targeted interventions to improve their outcomes. We implemented a 5-question frailty assessment tool for patients 65 years and older admitted to the general and vascular surgery services from January 1, 2018 to December 31, 2019. Identified frail patients received evidence-based clinical orders and nursing care plan interventions tailored to optimize recovery. A RE-AIM framework was used to assess implementation effectiveness through provider and nurse surveys, floor audits, and chart review. Of 1,158 patients included in this study, 696 (60.1%) were assessed for frailty. Among these, 611 patients (87.8%) scored as frail or intermediately frail. After implementation, there were significant increases in the completion rates of frailty-specific care orders for frail patients, including delirium precautions (52.1% vs 30.7%; p < 0.001), aspiration precautions (50.0% vs 26.9%; p < 0.001), and avoidance of overnight vitals (32.5% vs 0%). Floor audits, however, showed high variability in completion of care plan components by nursing staff. Multivariate analysis showed significant decreases in 30-day complication rates (odds ratio 0.532; p < 0.001) after implementation. A frailty assessment was able to identify elderly patients for provision of targeted, evidence-based frailty care. Despite limited uptake of the assessment by providers and completion of care plan components by nursing staff, implementation of the assessment and care interventions was associated with substantial decreases in complications among elderly surgical patients.

Qualitative exploration of the challenges and the benefits of the nursing process in clinical practice: A study among registered nurses in a municipal hospital in Ghana

AimThis study aims to explore the challenges and benefits of using the nursing process in a Ghanaian Hospital.DesignThe study employed a qualitative descriptive design to explore the challenges and the benefits of the utilization of the nursing process.MethodsTwelve (12) Registered Nurses were recruited for the study using purposive sampling. Recorded in‐depth interviews were conducted and data were analysed using thematic analysis.ResultsThe study found a low nurse‐to‐patient ratio, inadequate knowledge, apathy, inadequate logistics, poor supervision as challenges. However, quality and cost‐effective care improved nurse–patient relationships, and job satisfaction was found to be the benefits of nursing process use. Interventions to improve its utilization should be targeted towards improving the nurse‐to‐patient ratio, provision of adequate resources and inclusion of the nursing care plan in patient folders.

Nursing care plan for patients operated on for Lumbar Herniated Disc at CCOI Frank País

Introduction: lumbar disc herniation is as old as mankind. It has been described since ancient times, when man began to adopt the bipedal position and to support the entire weight of the body on his spine. According to the World Health Organization, herniated discs represent a great universal health problem. Objective: To design a care plan for patients operated on for lumbar disc herniation in the International Medical Attention Service (AMI) of the Frank País International Orthopedic Scientific Complex, deepening the knowledge of said pathological entity and identifying the socio-demographic characteristics of the staff, as well as the needs affected in patients during the period 2018-2019. Methodology: Descriptive cross-sectional study at the Frank País International Orthopedic Scientific Complex during the period 2018-2019. The sample was represented by all the nurses who work in the service (N = 13). The following variables were taken into account: age, sex, nursing degree, postgraduate completion, assessment of the physical and emotional needs of the patient, and the actions of the nursing staff to meet the needs. Results: The age of 40 to 45 years predominated (61.5%), 100% belonged to the female sex and all were professionally overcome by training. 61.5% were graduates. The needs in patients operated on for lumbar disc herniation were pain, physical activity and personal hygiene, which were found in all the patients studied. 38.4% of the personnel carried out insufficient actions, this corresponded to those who were technician qualifications. Conclusions: The design of a standardized nursing care plan regulated by the taxonomies NANDA, NIC, NOC, allowed structuring the scientific practice from the assessment to the evaluation of the results in the patient operated on for lumbar disc herniation admitted to the service of International Medical Care.

The Korean version of the Virtual Patient Learning System Evaluation Tool: Assessment of reliability and validity

BackgroundDue to the recent spread of coronavirus disease 2019, Korean nursing colleges are increasingly using virtual patient simulation to make up for a lack of available clinical practice in medical institutions. Therefore, an instrument is required to evaluate the effects of the virtual patient learning system in South Korea. ObjectiveTo assess the validity and reliability of the Korean version of the Virtual Patient Learning System Evaluation Tool (K-VPLSET). DesignThis is a methodological study. SettingsThis study was conducted via an online survey for Korean nursing students. ParticipantsThe present study included 373 participants who were 3rd and 4th year Korean nursing students. MethodsAfter translating the English version of VPLSET into Korean, a pilot test with a cognitive interview was undertaken to ensure that the meaning of original instrument and appropriateness for Korean nursing students had been retained. The content validity of the K-VPLSET was examined by a panel of six experts. Convenience sampling was used to recruit 3rd and 4th year Korean nursing students, among whom 170 were recruited for exploratory factor analysis (EFA) and 203 for confirmatory factor analysis (CFA). SPSS version 26.0 was used for EFA, whereas AMOS version 22.0 was used for CFA. ResultsFrom the 32 initial items, the final version of the K-VPLSET ultimately included 20 items, with a Cronbach's α of 0.89. EFA identified four factors (“Nursing Knowledge Improvement,” “Clinical Competency Development,” “Confidence in Nursing Performance,” and “Nursing Care Plan Application”) that explained 56.9% of the total variance. CFA confirmed the validity of the instrument. ConclusionsOur findings confirmed that the K-VPLSET is a valid and reliable instrument for assessing the effects of the virtual patient learning system, through which the quality of e-learning for Korea nursing students can be determined.

Health-related quality of life in diabetes mellitus patients in primary health care

ObjectiveTo analyse the relationship between health-related quality of life (HRQoL) and sociodemographic and clinical factors in patients with diabetes mellitus, also comparing with Spanish population-based reference values. MethodCross-sectional descriptive-analytical observational study through nonprobability sampling on diabetic patients from San Roque Primary Health Centre (Badajoz, Spain), using a questionnaire regarding sociodemographic and diabetes care data, SF-36 and Duke-UNC questionnaires, and clinical history data. ResultsSixty patients (55% women) fundamentally with type 2 diabetes and a mean age of 68.67 ± 11.09 years were studied. Women older than 75 presented poorer HRQoL than their reference group. Women showed worse HRQoL than men. Age, evolution of diabetes, presence of acute and chronic complications, and comorbidities, pharmacological treatment, and glycaemic control affect HRQoL in these patients. Living alone, having a low socioeconomic status, and needing help with diabetes-related self-care can negatively affect quality of life. ConclusionsHRQoL assessment allows us to detect alterations in the different domains and perform an early intervention. This way, we can incorporate these aspects into the nursing evaluation and interventions in the nursing care plan; allowing us to develop individualized care strategies and diabetes education programmes that contribute to improving HRQoL in patients with diabetes.

The impact of lack of affection and poor social ties in the nurses work environment: evidence from a Portuguese sample

Abstract Background Significant evidence has pointed out the positive impact of caring with love. Nurses are the healthcare professionals whose love gives a self–sacrificing spirit. However, little is still know about how lack of affection and unhealthy social ties affects Nurses in the work environment. This study sought to explore the association between affection, social ties and work environment. Methods Descriptive, correlational and cross-sectional study conducted with 36 Nurses of a private hospital in a city of Porto, Portugal. The ‘Fantastic Lifestyle’ and ‘Nursing Practice Work Environment’ scales, adapted and validated to the Portuguese population, with good internal consistency and reliability, were applied. The study was conducted between February and March 2020. Statistical analyses were performed through SPSS. Results Female nurses (80.6%), single (61.1%) and with an average age of 29 years (SD = 5.15) prevailed. 94.4% almost always have someone to talk to about important matters and 88.9% report that they almost always gave and received affection. Weak social ties negatively affect the perception that doctors and nurses have a good working relationship (χ2 = 8.145; P = 0.043) and collaboration (χ2 = 8.145; P = 0.043), resulting in a depreciation of colleagues skills (χ2 = 8.603; P = 0.014). Lack of affection negatively affects the perception of doctors and nurses collaboration (χ2 = 17.708; P = 0.001), the updating of nursing care plans (χ2 = 9.267; P = 0.008) and the relevance of nursing diagnosis applicability (χ2 = 7.650; P = 0.022). Conclusions Findings encourage the need to pay attention to nurses’ affection level and social ties strengthen, once the imbalance of one of these dimensions negatively influences the quality of work environment, impacting the quality of health care provided.