Nursing Process Model Research Articles

A STUDY TO ASSESS THE EFFECT OF CRYOTHERAPY ON PAIN AND SELECTED BIOPHYSIOLOGICAL PARAMETERS DURING ARTERIOVENOUS FISTULA CANNULATION AMONG PATIENTS ON MAINTENANCE HAEMODIALYSIS

The current study entitled a study to assess the effect of Cryotherapy on pain and selected Biophysiological parameters during arteriovenous fistula cannulation among patients on maintenance Hemodialysis at KMCH, Coimbatore was undertaken, during the year 2010 - 2011 in partial fulfillment of the requirement for the degree of Master of Science in Nursing at KMCH College of Nursing, Coimbatore which is affiliated to Dr. M.G.R. Medical University, Chennai. Objectives: To assess the pain intensity during Xylocaine infiltration. To determine the effect of Cryotherapy on pain and Biophysiological parameters during AV fistula cannulation. To associate the level of pain with selected demographic variables. Design: Repeated Measures design. Setting: Hemodialysis unit of Kovai Medical Center and Hospital, Coimbatore. Sample: Sample size was 50. Conceptual framework: Modified Orlando‟s Nursing process model. Outcome measures: The demographic data was collected from the subjects. The pain intensity was measured during cannulation with Xylocaine and with Cryotherapy using Numerical Pain rating Scale. The investigator recorded the Biophysiological parameters during the procedure. Intervention: Cold application was done prior and during cannulation over on the web between the thumb and index finger of the hand which does not have the AV fistula. Results: The mean pain score with Xylocaine infiltration at arterial site was 4.81 and at the venous site was 4.86.There was a significant reduction in the pain score during cannulation with the application of Cryotherapy. The mean pain score during cannulation after Xylocaine at the arterial site was 1.59 and at the venous site was 1.51 whereas the mean pain score during cannulation after Cryotherapy was 0.96 and 0.92 correspondingly. But there was no statistically significant difference between the values of Biophysiological parameters such as BP, PR and RR during cannulation done with Xylocaine and with Cryotherapy. There was no significant association between pain score and age and gender of the subjects but there was significant association between pain and duration of illness and duration of treatment Conclusion: Cryotherapy is an effective nonpharmacological measure in reducing pain during AV fistula cannulation among Hemodialysis patients.

Assessing the Effectiveness of a Planned Teaching Programme on Knowledge and Skills Regarding Breast Self-examination Among Female Teachers of selected High School of South Goa

A pre-experimental study was conducted to assess the effectiveness of planned teaching programme on knowledge and skills regarding breast self-examination, among female high school teachers of selected school in South Goa with the objectives to assess the knowledge and skills on breast self-examination and to evaluate the effectiveness of a planned teaching programme on knowledge & skills. The Orlando' s Nursing Process model (1950) was utilised for the study. Purposive sampling technique was used to select the setting and samples. Pre-experimental one group pre-test post-test research design was adopted for the present study. The tool consisted of a baseline demographic proforma, a structured questionnaire to assess the knowledge, observational checklist to assess skills; a model of breast made up of latex was utilized for demonstrating the steps of breast self-examination. Data was collected among 30 female high school teachers from the selected school of south Goa. A significant difference in pre-test and post-test knowledge score was 10.07 and skill score was 9.96 among female high school teachers after attending teaching programme on breast self-examination at p'lt;0.05. Spreading awareness through health education can help an individual to gain knowledge and develop the skills on breast self-examination.

Updating the Standardized Terminology for Nurses' Daily Documentation.

In Finland, the nationally unified and standardized nursing documentation model comprises the nursing process model and the Finnish Care Classification (FinCC). The aim of the study was to assess how well the further developed FinCC complies with actual nursing practices and how pragmatic and understandable it is. An e-questionnaire based on the revised version of the FinCC was sent to healthcare organizations (n=34) and Universities of Applied Sciences (n=14). Data was gathered and organized in Excel. Narrative comments were read and analyzed. The mean of questions of 17 components of both the FICND and the FICNI was over four (scale 1-5). The biggest revision of the FinCC is that different scales and evidence-based research have been utilized in the development of the terminology. Based on the findings, revisions have been made, and the new version, FinCC 4.0, will be published at the end of 2019.

Effects of Health Belief Model-based Education on Maternal Abilities to Caring for Children With Avoidant Restrictive Food Intake Disorder

Background: Health education, using new approaches in the nursing area, is of great importance. The current study aimed to evaluate the effects of a health belief model-based education on maternal abilities to caring for children with Avoidant Restrictive Food Intake Disorder (ARFID). Methods: This was a quasi-experimental non-randomized controlled trial with pre-test, post-test and a control group design. In total, 30 families with children with ARFID in Malang regency, Indonesia were divided into experimental and control groups. The experimental group was trained based on the Health Belief Model (HBM); however, the control group received an education based on the routine nursing process model. The necessary data were collected by a researcher-made questionnaire constructed based on HBM constructs. The obtained data were analyzed in SPSS. Descriptive statistics, homogeneity test, and Paired-Samples t-test were used to outline the relationship between the dependent and independent variables. Results: HBM effectively improved maternal abilities to manage eating disorders (P=0.009), promoting behaviors (P=0.000), and paternal involvement (P=0.000). Conclusion: HBM-Based education is recommended to be used in the provision of training in the mothers of children with ARFID.

Using Electronic Software for Nursing Documentation in Nursing Students.

AIMThis study aimed to assess the effect of using electronic software for nursing documentation on students.METHODA quasi-experimental study was performed. The study population comprised 80 nursing students who were randomly divided into 2 groups. The software used for nursing documentation was designed according to the nursing process model. Students in the experimental group received theoretical and practical training. The control group attended a 1-day course on the nursing process model. A questionnaire was used to assess student satisfaction in nursing documentation. The data were analyzed using the Statistical Package for Social Sciences software 16 (Chicago, USA). The standard and comprehensiveness of documentation were analyzed using the summative content analysis with the MaxQDA 10 software (USA). TREND statement was followed for reporting.RESULTSThe analysis showed that the mean scores of satisfaction in both groups increased significantly (p < .05). Furthermore, the result of the summative content analysis showed that the comprehensiveness and the standard of nursing documentation increased significantly in the experimental group (p < .05).CONCLUSIONThe findings confirmed the usefulness of electronic software in improving the standard and comprehensiveness of nursing documentation and the students’ satisfaction.

Transformational Leadership Educational Bundle for Nursing Supervisors and Nurses in-Charges and its Impact on Clinical Performances of the Nurses in the Labour Room

Background: In the process of transformational leadership, leaders and followers have mutual understandingand help each other to promote a higher levels of morale and motivation among them. Employees in theorganization take ownership of their roles and responsibilities and perform the work activities out ofexpectation of the leaders, leaders describe only the goals and objectives of the organization.Methodology: In this study quantitative research approach was used and one group pretest posttest quasiexperimental research design was used. The study conducted in the labour rooms of selected maternityhospitals. The samples were nursing supervisors, nursing in-charges and nursing officers of the maternitywards and participants were chosen by adopting convenient sampling technique. Structured questionnairewas used, one tool consisted of 20 questions regarding knowledge on transformational leadership andanother tool comprised of clinical performance evolution check list. Tools were validated by the expertsand reliability values includes Cronbach’s alphas were r= 0.88, &amp; 0.96 for knowledge transformationalleadership and nurses’ job performance evaluation respectively.Results: Majority of the nursing officers were falling under the category of age between 26 to 30 years.Around 62 % of the nursing officers have an experience of 6 to 10 years. Majority of the nursing officershave completed GNM qualification. About 40 % of the nursing supervisors and nursing in charges havecompleted BSc Nursing qualification. In pretest, majority of supervisors and in charges have poor knowledgeregarding transformational leadership while in post test77 % of subjects gained the good knowledge. Inposttest majority of the nursing officers were competent in establishing the expected behavior of leaders,maintaining nursing process model, providing quality of the care and adequate information and education tothe patients and relatives as per the requirement.Conclusion: It is concluded that, as transformational leadership is successful in many domains of healthcare delivery system, and this study results showed that, using transformational is effectives labour roomand other maternity wards for successful maternal and newborn outcome.

Nursing Care Audit Based on Nursing Process Model and Ensuring Patient Safety among Staff Nurses

The nursing process model involves assessing, diagnosing, planning, implementing and evaluating patient situations. In this study to audit nursing care, using a nursing process model, nursing audit checklist was designed based on nursing process model. The demographic questionnaire contained nurses’ age, gender, work experience, type of employment, education level, and work shift. Nurses’ performance was assessed using the audit checklist during a single work shift. Some indicators were assessed through a review of documents and nursing notes. Sample size was 100. The results showed that the majority of nurses (about 80%) worked in rotational shifts, 70 percent had 5 - 10 years of experience and 90 percent had GNM qualification. The rate of least compliance with nursing process indicators was 12.6, confirming that the majority of nursing care was not carried out based on the nursing process. The mean overall compliance score significantly differed between nurses with a BSc and those with GNM (p=0.04). This difference was also found in the mean compliance scores for three domains, diagnosis (p=0.001), implementation (p=0.02), and evaluation (p=0.01). In addition, the overall mean score did not significantly differ between nurses with permanent and non-permanent employment (t=0.123, p=0.42). The finding revealed that the knowledge of nurses on the nursing process is not adequate to be put into practice and high patient nurse ratio affects its application.

OUTCOME PRESENT TEST METHOD (OPT) IMPROVE THE SATISFACTION OF CLINICAL REASONING STUDENT PROFESSION IN MEDICAL NURSING SURGERY STAGE

Nursing clinical education is an instrument in improving the clinical reasoning skills of students. One of learning models of clinical reasoning that is used to improve clinical reasoning skills in nursing education is the Outcome-Present Test Model (OPT). OPT is a nursing process model that is designed to develop the skills of learners’ clinical reasoning and the focus of the model are the results (outcomes) and thinking behind (backward) to change the client from his health status at this time (the present state) to the desired state (outcome ). In other words, a very simple model that consists of only 1 (one) page makes the learning improving clinical reasoning skills more easily and reduce the element of copy and paste in the documentation. While peer learning is an effective strategy to address the problem in which the students will be divided into several groups of 2-3 students.To obtain the result, this learning model uses research development method with the respondents 10 clinics and institutions preceptor and 30 students who practice in medical surgical nursing stase.The research results shows the level of student satisfaction after using Outcome-Present Test (OPT)-peer learning for 4 weeks, it affected with the value of α: 0,001. By using this model, not just a clinical reasoning that they get but they also will understand about how to use the diagnosis of NANDA, NIC and NOC. The next suggestion, this model can be a format in clinical learning in other departments.

Application of Nightingale Nursing Theory to the Care of Patient with Colostomy

Nursing is distinct health care discipline and its practice is based on the paradigm of care. The theoretical foundation of discipline is rich of various, Grand and middle range theories and care models The clinical Domaine of discipline is a platform to test the theoretical aspect of discipline. Both theory and practice are reciprocal as theories generate from practice and return back to practice for testing. Florence nightingale was the pioneer nurse theorist and founder of modern nursing. Her theory of care which more than a century old is still appropriate for application to the care of patients undergoing a surgical operation colostomy. This paper is aimed to discuss the practical application of nightingale theory to the care of colostomy patient in hospital setting. Nursing process model of care was used to integrate nightingale theory to a clinical scenario. Successful attainment of care out comes achieved by application of nightingale theory to nursing care of patient with colostomy.

Construction and validation of a systematization instrument for nursing in intensive care

Objective: construction and validation of a systematization instrument for Nursing Care, characterizing the profile of patients of an intensive care unit in the north of Brazil. Methods: it was a descriptive methodological study that followed a nursing process model in five phases. Results: it was suggested that the instrument be constructed in two formats; one for admission and another for daily assessment. Some items were removed from the instrument according to content validation content by the nurses. Of the 45 patients evaluated, 60.0% were men, 44.0% were married, 40.0% had low education levels, chronic renal failure and cancer. The main nursing diagnoses were risk for infection (100.0%) and impaired physical mobility (97.8%). The main nursing interventions were: handwashing, changing intravenous access, performing aseptic techniques and moving patients every 2 hours. Conclusion: construction and content validation were carried out successfully, promoting instruments capable of providing quality nursing care for patients in intensive care.

Construction and validation of a systematization instrument for nursing in intensive care

Objective: construction and validation of a systematization instrument for Nursing Care, characterizing the profile of patients of an intensive care unit in the north of Brazil. Methods: it was a descriptive methodological study that followed a nursing process model in five phases. Results: it was suggested that the instrument be constructed in two formats; one for admission and another for daily assessment. Some items were removed from the instrument according to content validation content by the nurses. Of the 45 patients evaluated, 60.0% were men, 44.0% were married, 40.0% had low education levels, chronic renal failure and cancer. The main nursing diagnoses were risk for infection (100.0%) and impaired physical mobility (97.8%). The main nursing interventions were: handwashing, changing intravenous access, performing aseptic techniques and moving patients every 2 hours. Conclusion: construction and content validation were carried out successfully, promoting instruments capable of providing quality nursing care for patients in intensive care.

The effectiveness of discharge planning on the knowledge, clinical symptoms and hospitalisation frequency of persons with schizophrenia: a longitudinal study in two hospitals in Tehran, Iran

To investigate the effectiveness of discharge planning on the knowledge, clinical symptoms and frequency of hospitalisation of persons with schizophrenia. Discharge planning is associated with decreases in the duration of hospitalisation, readmission to hospitals and decreases in medical costs. Yet, there is little known about the effectiveness of discharge planning among persons with schizophrenia in Iran. Longitudinal clinical trial. In this longitudinal clinical trial, 46 persons with schizophrenia admitted to psychiatric hospitals were selected and classified into either intervention or control groups. For the intervention group, the discharge planning was designed using the nursing process model. The intervention was implemented across six sessions in the hospital and six sessions in patient's home (up to three months after discharge). Friedman test, independent t-tests, chi-squared test, Mann-Whitney U-test and Mc-Nemar's test were used to analyse demographic characteristics, knowledge scores, clinical symptoms and the frequency of hospitalisation. The intervention group demonstrated improved clinical symptoms between the time of discharge and three months after discharge and had higher knowledge levels compared with the control group. In addition, the frequency of patients' hospitalisation preintervention and three months postintervention was statistically significantly lower in the intervention group, while no such differences were found among the control group during this same time period. This study suggests that there are a number of advantages to discharge planning including an increase in the knowledge of patients, a decline in clinical symptoms and a reduction in the frequency of admission to hospitals. Due to high frequency of relapse, rehospitalisation and high remedial costs of persons with schizophrenia, it is important to consider discharge planning as a therapeutic approach for patients.

Impacts of structuring nursing records: a systematic review

The study aims to describe the impacts of different data structuring methods used in nursing records or care plans. This systematic review examines what kinds of structuring methods have been evaluated and the effects of data structures on healthcare input, processes and outcomes in previous studies. Retrieval from 15 databases yielded 143 papers. Based on Population (Participants), Intervention, Comparators, Outcomes elements and exclusion and inclusion criteria, the search produced 61 studies. A data extraction tool and analysis for empirical articles were used to classify the data referring to the study aim. Thirty-eight studies were included in the final analysis. The study design most often used was a single measurement without any control. The studies were conducted mostly in secondary or tertiary care in institutional care contexts. The standards used in documentation were nursing classifications or the nursing process model in clinical use. The use of standardised nursing language (SNL) increased descriptions of nursing interventions and outcomes supporting daily care, and improving patient safety and information reuse. The nursing process model and classifications are used internationally as nursing data structures in nursing records and care plans. The use of SNL revealed various positive impacts. Unexpected outcomes were most often related to lack of resources. Indexing of SNL studies has not been consistent. That might cause bias in database retrieval, and important articles may be lacking. The study design of the studies analysed varied widely. Further, the time frame of papers was quite long, causing confusion in descriptions of nursing data structures. The value of SNL is proven by its support of daily workflow, delivery of nursing care and data reuse. This facilitates continuity of care, thus contributing to patient safety. Nurses need more education and managerial support in order to be able to benefit from SNL.

Defining the paramedic process

The use of a 'process of care' is well established in several health professions, most evidently within the field of nursing. Now ingrained within methods of care delivery, it offers a logical approach to problem solving and ensures an appropriate delivery of interventions that are specifically suited to the individual patient. Paramedicine is a rapidly advancing profession despite a wide acknowledgement of limited research provisions. This frequently results in the borrowing of evidence from other disciplines. While this has often been useful, there are many concerns relating to the acceptable limit of evidence transcription between professions. To date, there is no formally recognised 'process of care'-defining activity within the pre-hospital arena. With much current focus on the professional classification of paramedic work, it is considered timely to formally define a formula that underpins other professional roles such as nursing. It is hypothesised that defined processes of care, particularly the nursing process, may have features that would readily translate to pre-hospital practice. The literature analysed was obtained through systematic searches of a range of databases, including Ovid MEDLINE, Cumulative Index to Nursing and Allied Health. The results demonstrated that the defined process of care provides nursing with more than just a structure for practice, but also has implications for education, clinical governance and professional standing. The current nursing process does not directly articulate to the complex and often unstructured role of the paramedic; however, it has many principles that offer value to the paramedic in their practice. Expanding the nursing process model to include the stages of Dispatch Considerations, Scene Assessment, First Impressions, Patient History, Physical Examination, Clinical Decision-Making, Interventions, Re-evaluation, Transport Decisions, Handover and Reflection would provide an appropriate model for pre-hospital practices.

Development of the Quality of Australian Nursing Documentation in Aged Care (QANDAC) instrument to assess paper-based and electronic resident records

To develop an Australian nursing documentation in aged care (Quality of Australian Nursing Documentation in Aged Care (QANDAC)) instrument to measure the quality of paper-based and electronic resident records. The instrument was based on the nursing process model and on three attributes of documentation quality identified in a systematic review. The development process involved five phases following approaches to designing criterion-referenced measures. The face and content validities and the inter-rater reliability of the instrument were estimated using a focus group approach and consensus model. The instrument contains 34 questions in three sections: completion of nursing history and assessment, description of care process and meeting the requirements of data entry. Estimates of the validity and inter-rater reliability of the instrument gave satisfactory results. The QANDAC instrument may be a useful audit tool for quality improvement and research in aged care documentation.

Nursing documentation: Experience of the use of the nursing process model in selected hospitals inIbadan,OyoState,Nigeria

The descriptive study was conducted to determine the extent of utilization of the nursing process for documentation of nursing care in three selected hospitals, Ibadan, Nigeria. One hundred fifty nurses and 115 discharged clients' records were selected from the hospitals. Questionnaires and checklists were used to collect data. Utilization of nursing process for care was 100%, 73.6% and 34.8% in the three hospitals. Nurses encountered difficulties in history taking, formulation of nursing diagnoses, objectives, nursing orders and evaluation. Most nurses disagreed or were undecided with the use of authorized abbreviations and symbols (34.3%, 40.3% and 69.5%), recording errors that occurred during care (37.1%, 56.1% and 52.2%) and inclusion of change in clients' condition (54.3%, 56.1% and 73.8%). Most nurses appreciated the significance of documentation. Lack of time, knowledge and need for extensive writing are the major barriers against documentation. Seventy-seven point four per cent of the 115 clients' records from one hospital showed evidence of documentation, no evidence from the other two. Study findings have implications for continuing professional education, practice and supervision.

Evaluation of the national nursing model and four nursing documentation systems in Finland – Lessons learned and directions for the future

ObjectivesTo evaluate the feasibility of the national nursing model and usability of four widely used nursing documentation systems and to study their usefulness in multi-professional collaboration and information exchange. MethodsQualitative usability study methods were used, including the use of scenario walkthroughs, contextual inquiries, thematic interviews and inspection-based expert reviews in the users’ clinical contexts. ResultsThe nursing process model was shown to be feasible in nursing practice but the national nursing classification was considered too detailed, multi-layered and difficult to use and understand. The four evaluated nursing documentation systems had many usability problems which resulted in them being difficult to use and produced extra documentation workload. Generally, electronic nursing documentation improves patients’ and health professionals’ legal protection and makes nursing care more transparent; however, the documentation systems did not provide good support for multi-professional care and information exchange. ConclusionsNursing models should comply better with nursing practices and support nurses in patient care and interventions. An essential improvement in practice would be the use of specific templates that are easy to apply in specific situations with homogeneous patient groups. Collaborative care aspects and better utilization of information require that the nursing model is designed to support not just documentation but also information utilization.

Evaluation of electronic nursing documentation—Nursing process model and standardized terminologies as keys to visible and transparent nursing

Purpose The purpose of this study was to describe and evaluate whether nurses have documented patient care in compliance with the national nursing documentation model in electronic health records, which means the use of the nursing process and the use of standardized terminology in different phases of the nursing process. Methods The data were collected from a central hospital in 2003–2006. The data consist of the electronic nursing care plans of 67 neurological patients and 422 surgical patients. The data were analyzed using statistical methods and content analysis. Results Standardized electronic nursing documentation is based on the nursing process, although the use of the nursing process varies across patients. There is a lack of progress notes relating to needs assessment, the identification of nursing diagnoses and care aims, and the nursing interventions planned in the documentation. The standardized terminology is used in the documentation but inconsistencies emerge in the use of the different classifications. Conclusion The national model for electronic nursing documentation is suitable for the documentation of patient care in nursing care plans. However, health care professionals need further training in documenting patient care according to the nursing process, and in using the terminology in order to increase patient safety and improve documentation.

Evaluation of the Outcome-Present State Test Model as a Way to Teach Clinical Reasoning

The Outcome-Present State Test (OPT) Model of Clinical Reasoning is a nursing process model designed to help students develop clinical reasoning skills. Although many nurse educators are using the OPT model as a teaching strategy, few are formally evaluating its use as a method. We used the OPT model as a teaching tool in an undergraduate psychiatric and mental health clinical nursing course and evaluated how quickly students became adept at using it. Most students mastered the use of the model; 29 of 43 students achieved the criterion score (a score greater than 65 on 3 or more models completed over 4 weeks). Not only did the students gain clinical reasoning skills, but they also used and learned more about the North American Nursing Diagnosis Association, Nursing Interventions Classification, and Nursing Outcomes Classification languages. Recommendations for future use of the model include adding client strengths and increasing focus on the quality of students' responses.

A nursing process model for a hospital - systematic literature review

To implement a model of nursing process in hospital for high complexity clients a systematic literature review will be done ti identify best practices that can be utilized.