Nursing Process Research Articles

Representing Nursing Practice in EMR/EHRs.

Review of the ISO 18104 technical standard for a Nursing Categorial structure to best represent nursing practice in EMR/EHRs and digital health ecosystems. Application of ISO standard review guidelines in consultation with ISO member stakeholders. Comprehensive views of the nursing practice knowledge domain are presented as mindmaps. Groups of patients can now be identified using the 'type of subject of care' category. The collaborative role of nurses is now recognized. This high level structured information model recognises nursing diagnosis, nursing actions and nurse sensitive outcomes relative to other categories and sub-categories known to influence nursing actions and nurse sensitive outcomes. This nursing practice framework reflects the nursing process. It supports conceptual and logical analysis of patient journey related nursing practice. This updated categorial structure is a good fit with today's information technologies. Its adoption enables the value of nursing services provided to be demonstrated.

Knowledge status of skin tear prevention and its demographic and occupational influencing factors: A National cross-sectional survey among nurses.

A skin tear (ST) is a common skin injury that is often misdiagnosed or overlooked. This study examined the current state of nurses' ST knowledge and its influencing factors. A national cross-sectional survey combined with a quantitative analysis was used to provide evidence of poor ST knowledge among nurses and its influencing factors. An electronic questionnaire survey was conducted among 1293 nurses from 32 hospitals in 18 provinces across China, including a General Information Questionnaire, ST Knowledge Assessment Instrument (OASES) and a Self-directed Learning Competence Scale for Nurses (SLCS-N). The mean OASES score was 9.51 ± 3.15, with a score rate of 47.55%. Pearson's correlation analysis showed positive correlations, ranging from none to strong, between every dimension in the OASES and from strong to extremely strong between every dimension in the SLCS-N. Multivariate analysis revealed multiple independent factors influencing ST knowledge, such as hospital tier, specialized nurses in wound/ostomy/incontinence care, participation in training for wound/ostomy/incontinence management, willingness to undergo ST training, self-assessed grade in ST care and the degree of emphasis of managers. ST knowledge status was generally poor among nurses nationwide. Managers should establish a comprehensive and specialized curriculum-based system, develop evidence-based standardized nursing processes, and provide tailored training programs to address nurses' unique characteristics and individualized needs, thereby enhancing their proficiency in ST-related knowledge and skills. This study is the first to identify a poor level of ST knowledge among nurses nationwide, particularly in the four dimensions of risk assessment: prevention, treatment, classification, and observation. Based on the findings regarding demographic factors and ST experiences, an integrated management system and educational program should be implemented to improve nurses' awareness and knowledge in this field. No patient or public contributions.

Nursing process for patients with chronic wounds: A series of successful cases

The care of patients with chronic wounds represents a significant challenge for nursing. Recently, healing protocols have been developed that employ extracellular matrices (ECM), achieving complete wound regeneration. These protocols require an individualized care plan led by nurses, who work in multidisciplinary teams and provide a holistic view of the patient, thus improving care management processes. The nursing process, which includes research, logical analysis and interpersonal techniques, has been shown to improve the quality of care. In this study, evidence was presented on the successful management of chronic wounds through a comprehensive protocol in a first level hospital in Girón, Colombia. Three patients with venous insufficiency who had received conventional management without success were selected. The assessment was performed using the NANDA domains, with a diagnosis of impaired skin integrity. The protocol included disinfection, application of Regenesis® matrix and appropriate dressings, with daily photographic follow-up. The first patient, a 74-year-old woman with a 22-year-old venous ulcer, showed complete wound closure in six weeks. The second patient, a 53-year-old woman with a five-year-old venous ulcer, achieved closure in five weeks. The third patient, a 47-year-old man with a three-year-old venous ulcer, experienced complete closure in eight weeks. All patients showed significant improvements in their wound characteristics and had no adverse events. The study concluded that the healing protocol, which integrates the nursing process, is effective in closing chronic wounds in a short period, even in patients who have not responded to conventional treatments. These results underscore the importance of strict adherence to standardized protocols and nurse-patient interaction for successful treatment

Moral courage of emergency nurses in care-limited environments: A mixed-methods study.

Professional ethics in nursing exist to guide care and allow for decision-making to be patient-centered. In the current medicolegal landscape post-Roe and in light of bans on gender-affirming care, the decision-making processes of emergency nurses in the clinical environment of care as informed by both professional and personal ethics are an important area of inquiry. The aim of this study was to examine the contribution of moral courage to decision-making by emergency nurses. A mixed-methods exploratory sequential approach was used, using a standard demographics form and the Nurses Moral Courage Scale to collect quantitative data. These data were used to inform an interview guide for qualitative data collection. Situational analysis was used to analyze the interview data. Prior to recruitment, this study was reviewed and approved by the University of Massachusetts IRB (#00003909). Participants were provided with an informed consent document at the time of registration and at the time of interview; participants provided both signed consent and verbal assent. Participants were assigned study codes to maintain anonymity and data were maintained in a secure University cloud. US-based emergency nurses working in environments with care limitations. 70% of respondents reported that they would speak up if they were aware of a situation that was ethically challenging. Respondents reported that it was fairly easy or very easy to defend their values when addressing ancillary staff, coworkers, authorities outside the organization, patients, and patient families. Respondents reported challenges in defending their professional values to charge nurses, physicians, or administrators. In response to a serious ethical problem, 65.8% of respondents answered that they would bring up the problem for discussion, 21.1% would file an internal report, and 13.2% would report externally. Interview participants reported significant social and professional barriers to acting in response to an ethical violation. Willingness to act centered on personal values and not professional codes of ethics. While emergency nurses in this study reported high perceived levels of moral courage, they also reported low willingness to act directly, citing burnout and significant social and professional barriers. Adherence to professional codes of ethics is not the primary driver of moral courage.

The influence of individual factors on the career preferences and specialty choices of final-year nursing students

BackgroundStatistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students' viewpoints. PurposeThe aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors influence the final-year nursing students' career decision-making process. MethodA narrative inquiry approach using semi-structured interviews was carried out with purposively sampled nursing students (n = 12) who had undertaken a final-year clinical placement(s). Data was analysed using two main steps. First, the interviews were restoried and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes. ResultsData analysis generated three main themes: demographic factors, social factors, and career goals. Participants' characteristics and interactions with other individuals and systems influenced their nursing specialty preferences and professional career plans. ConclusionNursing students' career interests are influenced by individual factors external to their nursing education, such as their age, gender, and life experiences. These student characteristics and experiences facilitated or inhibited a career in some nursing specialties, with the students gauging their ability to practice in a specialty during their CPs. Nursing education should expose and inform students about the core skills, career opportunities, and how to advance their careers in the different nursing specialties. Most importantly, final-year students may need formal career guidance to encourage nursing students' positive attitudes and career interests in different nursing specialties and make realistic career decisions.

'Implicit rationing of nursing care processes'-Decision-making in ICU nurses' experiences: A qualitative study.

Implicit rationing of nursing care is defined as the withholding of necessary nursing measures for patients because of a lack of nursing resources. However, no studies have explored the experience of decision-making about implicit rationing of nursing care in an intensive care unit (ICU). To explore the process of ICU nurses' decisions and judgement based on the conceptual framework of implicit rationing of nursing care. A qualitative study was undertaken between June 2020 and September 2020. The data collection methods were participative observation and interview. Eighteen ICU nurses participated in interviews. A thematic analysis was performed for the data analysis. The following five themes emerged: assessment of the condition and nature of nursing and time taken; strategies for setting personal priorities; plan implementation under mitigation strategy; existing nursing in reality; evaluation of the implementation of implicit rationing care. Nurses choose different strategies during plan implementation. In the absence of explicit guidelines on rationing nursing care, nurses often rely on intuitive and situational decision-making processes for setting priorities. Given the vulnerability of ICU patients and the absence of family caregivers, nurses bear a heightened ethical responsibility to provide care. Establishing a positive nursing culture is essential. It is both reasonable and effective to organize work by accurately quantifying workload, improving staffing levels and optimizing scheduling methods. These themes align with the decision-making process outlined in the conceptual framework and offer fresh perspectives. Nurses have a greater responsibility to provide care in an ethical manner and to increase awareness of the importance of holistic nursing care for the patient, that is to raise awareness of the importance of care that is often missed. Nurses actively adopt strategies to reduce implicit rationing of nursing care, including teamwork, organized nursing, working overtime and ignoring quality. The findings highlight the importance of creating a positive nursing culture that encourages nurses to adopt positive strategies.

Maintaining Stabilization of Blood Sugar Levels in Diabetes Mellitus Patients with Foot Exercises: Case Report

The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs. Physical activity is one of the factors that affect glycemic management. This case study aims to maintain the stability of blood sugar levels in DM patients by applying leg exercises. The design of this research is a case report with a nursing process approach carried out on Diabetes Mellitus patients with nursing problems of unstable blood sugar levels. Nursing care was carried out for seven days at the Muhammadiyah Ponorogo General Hospital. The intervention implemented is foot exercises. The results of the case study are presented in the form of nursing documentation. The case study results showed that the patient's blood sugar levels tended to be stable starting on the second day of the intervention.Exercise-induced glycemic control is mostly explained by an increase in whole-body insulin sensitivity. The long-term advantages of frequent exercise on glycemic control appear to be related to the cumulative effect of transitory gains in insulin sensitivity and glycemic control after each bout of exercise, rather than structural changes in insulin sensitivity. Keywords: blood sugar level; diabetes mellitus; foot exercise

Asuhan Keperawatan pada Lansia Wanita dengan Penerapan Pelvic Floor Muscle Exercise terhadap Frekuensi Berkemih

In old age, physiologically the body's cells can decline, resulting in decreased body function and endurance. One example is the urinary system which will affect changes or instability in the function of the urinary tract, so that the elderly will experience abnormal urination patterns. The management that can be carried out as an effort to restore the function of the urinary tract, especially the frequency of urination, is pelvic floor muscle exercise. Can analyze gerontic nursing care in the elderly to control decreased urinary tract function. This case study uses a descriptive method with a nursing process approach which was carried out on 3 patients using a one group pretest posttest research design. There was a change in the frequency of urination in the three respondents who had implemented pelvic floor muscle exercises. It is hoped that this nursing care report can become a reference in gerontic nursing care for the elderly with decreased urinary tract function.

Penerapan Terapi Bermain Meniup Baling-Baling Pada Anak Sekolah Dengan DBD Terhadap Penurunan Intensitas Nyeri Setelah Pemasangan Infus

The process of installing an IV will cause pain which can disturb the child. Pain is an unpleasant event in individuals that can cause sufferers to feel sick. Apart from that, there will be changes in vital signs such as increased pulse rate, blood pressure and breathing, so it will be an unpleasant experience for the child. Pain from installing IV fluids in children can be minimized with non-pharmacological measures which aim to manage pain, namely with relaxation therapy, playing blowing propellers. To determine the effectiveness of blowing propeller play therapy on reducing pain in children when installing an IV. This research uses a descriptive case study with a nursing process approach with a case study design of 3 respondents, with a paper propeller game and the Wong Baker pain scale. The data collection process was carried out on respondents by blowing a propeller for 5 minutes on each respondent. The research results showed that play therapy blowing propellers was effective in reducing the intensity of pain in children after installing an IV as proven in An. B from scale 7 to scale 4, An. Z from scale 8 to scale 6, and An. R from scale 7 to scale 5. The results of the research are that it is hoped that propeller blowing therapy can reduce the intensity of pain in children after infusion.

The impact of AI-based decision support systems on nursing workflows in critical care units.

This research examines the effects of artificial intelligence (AI)-based decision support systems (DSS) on the operational processes of nurses in critical care units (CCU) located in Amman, Jordan. The deployment of AI technology within the healthcare sector presents substantial opportunities for transforming patient care, with a particular emphasis on the field of nursing. This paper examines how AI-based DSS affect CCU nursing workflows in Amman, Jordan, using a cross-sectional analysis. A study group of 112 registered nurses was enlisted throughout a research period spanning one month. Data were gathered using surveys that specifically examined several facets of nursing workflows, the employment of AI, encountered problems, and the sufficiency of training. The findings indicate a varied demographic composition among the participants, with notable instances of AI technology adoption being reported. Nurses have the perception that there are favorable effects on time management, patient monitoring, and clinical decision-making. However, they continue to face persistent hurdles, including insufficient training, concerns regarding data privacy, and technical difficulties. The study highlights the significance of thorough training programs and supportive mechanisms to improve nurses' involvement with AI technologies and maximize their use in critical care environments. Although there are differing degrees of contentment with existing AI systems, there is a general agreement on the necessity of ongoing enhancement and fine-tuning to optimize their efficacy in enhancing patient care results. This research provides essential knowledge about the intricacies of incorporating AI into nursing practice, highlighting the significance of tackling obstacles to guarantee the ethical and efficient use of AI technology in healthcare.

Penerapan Terapi Afirmasi Positif pada Pasien dengan Harga Diri Rendah di Rumah Sakit Jiwa Palembang

Low self-esteem is a persistent feeling of worthlessness and inferiority from negative self-evaluation of oneself. Complications for clients with low self-esteem include social isolation, hallucinations and violent behavior. The problem of low self-esteem requires appropriate intervention. One therapy that can be done by patients with low self-esteem is positive affirmation therapy. Positive affirmations are statements that strengthen positive beliefs within a person. This research aims to provide nursing care to mental patients with low self-esteem through positive affirmation therapy interventions at the Palembang mental hospital. The method used was a descriptive method with a nursing process approach on 3 patients with a One Group Pretest Posttest research design of positive affirmation therapy on patients with low self-esteem. The results of measurements via the Rosenberg Self Esteem Scale were obtained by the patient Mrs. Y with a score of 4 (low self-esteem) to 7 (high self-esteem), the score for Mrs. N with a score of 3 (low self-esteem) becomes 7 (high self-esteem) and Mrs. A with a score of 3 (low self-esteem) becomes 5 (low self-esteem). Conclusion: There is a decrease in the number of patients' self-esteem level scores through the Rosenberg Self-Esteem Scale measurement and a decrease in the number of symptoms that appear in patients with low self-esteem.

Penerapan Terapi Puzzle Untuk Meningkatkan Fungsi Kognitif Pada Lansia di Panti Werdha Palembang

An elderly person is someone who reaches the age of > 60 years. This increase in age will result in a decrease in the ability of the body's functions, one of which is the nervous system, namely a mild, moderate decline in cognitive function and even dementia. Severe dementia will result in elderly people being unable to carry out activities so that they will experience elderly people who are not prosperous and happy. To overcome this, puzzle therapy is needed. Puzzle therapy is a game of arranging certain shapes until they become a complete image or form a certain pattern. This is to stimulate and improve the cognitive function of the brain. It is known that nursing care for elderly people with decreased cognitive function is provided by providing puzzle therapy. This case study uses a descriptive method with a nursing process approach carried out on 3 clients using a One Group Pretest Posttest puzzle therapy research design on cognitive function in the elderly. The implementation results showed that there was a change in the MMSE score after being given puzzle therapy for 5 consecutive days, namely Mrs. F from 21 to 23, Mrs. L from 22 to 24 while Mrs. E of 16 and still has a score of 16. The average MMSE score which increased after being given puzzle therapy was 2 scores. It is hoped that the results of this case study can become an application for implementing puzzle therapy to improve cognitive function in the elderly where caregivers or nursing home staff can also make puzzle therapy a routine activity that can be carried out every week at the Dharma Bhakti KM 7 Palembang Nursing Home.

Nursing Quality Indicators in Emergency Nursing: A Scoping Review.

Nursing quality indicators (NQIs) are essential for evaluating and managing care, yet few validated NQIs exist for emergency nursing. The dynamic nature of this field demands specific, validated indicators. The purpose of this review was to identify NQIs in adult emergency nursing using Donabedian's quality categories (structure, process, outcome) and explore their validation. A scoping review was conducted including articles from 2010 to February 2023, using the Cumulative Index to Nursing and Allied Health Literature and Medline (Ovid) databases. Among 936 screened articles, 18 were included, identifying 85 NQIs across structure (n=14), process (n=45), and outcome (n=26) in emergency nursing. However, the validation of these NQIs was limited. NQIs evaluate emergency nursing quality, primarily in process assessment. Future work should validate the NQIs identified in this review for adult emergency nursing and search for potential new ones.

An environment conducive to well-being and nursing professionalism

There are three stages in the professionalization process for nurses, within which academic training and nursing science are developing. The evolution of initial training and the 2025 referential will require an integrative alternation that will reinforce skills. The professionalization of students should be based on the analysis of professional practices, in a caring and ecological environment for individuals.

A comprehensive picture of using standardized nursing languages in long-term care systems: An integrative review.

This integrative review was conducted to provide a comprehensive picture of the use of standardized nursing languages (SNLs) in long-term care (LTC) systems. A comprehensive search was performed with terminological variants of "standardized terminology" and "long-term care" in eight electronic databases up to December 2021. Eligible studies were further identified by screening the reference lists of publications that met the inclusion criteria. The quality of the included studies was appraised using the Joanna Briggs Institute checklists. The study findings were organized into themes, which represent the focus of the study. Eighty-one publications that studied 12 SNLs in 17 countries are presented in this review. The Omaha System, NANDA-I, NIC, and NOC were the most common SNLs. Study foci were classified into five themes: evaluating the applicability of 10 SNLs (n=22), characterizing nursing care using six SNLs (n=16), developing core sets and tools based on seven SNLs (n=15), documenting nursing care by using four SNLs (n=14), and implementing intervention programs based on six SNLs (n=14). SNLs can be used for various purposes, and the available evidence supports the expansion of their utilization. Further studies should continue to identify gaps in the existing versions of SNLs to reflect the LTC nursing process in multiple societies. Additionally, the successful use of SNLs requires background knowledge of nursing informatics; therefore, preparation should be started in the nursing curriculum and continued in healthcare facilities, including LTC settings. These research findings will assist healthcare managers, researchers, and policymakers in the LTC field in effectively utilizing SNLs.

The skin tears knowledge among geriatric ward nurses and associated factors: A cross-sectional study

AimTo determine the level of knowledge about skin tears among geriatric ward nurses and identify associated factors. MethodsIn this cross-sectional study in Southwest China, 1172 geriatric ward nurses from 10 hospitals participated. Data were collected using Sojump, a Chinese web-based platform, and the Skin Tear Knowledge Assessment Instrument was used to assess their knowledge. The analysis involved descriptive statistics, correlation analysis, and multiple linear regression. ResultsThe study involved participants with an average age of 36.73 (SD = 6.54) years. More than half of the participants had less than 10 years of experience in geriatric wards. 27 % specialized in wound care, and 68.1 % lacked specific training in skin tear (ST) knowledge. Additionally, 82.7 % of geriatric nurses had never been exposed to guidelines on ST prevention and management. In the geriatric ward, 36.6 % of nurses received training in ST prevention. The average knowledge score about Skin Tears (STs) was 9.52 (SD = 2.39) out of 18. 'Treatment' had the lowest mean score, while 'Specific patient groups' had the highest. The multiple linear regression analysis found that nurses' knowledge of STs was influenced by sex(β = 0.096, P < 0.001), educational level(β = 0.062, P < 0.001), participation in ST (β = −0.193, P < 0.001 and wound care training(β = −0.120, P = 0.004), and specialization as a wound care nurse(β = −0.350, P = 0.001). These factors explained 61.3 % of the variance in knowledge about STs among the participants. ConclusionThe geriatric ward had limited knowledge of STs. To improve their skills in dealing with STs, managers should provide tailored training to nurses and establish a standardized, evidence-based nursing process.

The implementation study of nurses’ work related low back pain prevention and care guideline: A quasi-experimental study

AimTo understand the implementation process and outcomes of nurses' work related low back pain (WLBP) prevention and care guideline. BackgroundWLBP is a common occupational injury for clinical nurses. We developed the first evidence-based guideline of nurses' WLBP prevention and care of its kind both at home and abroad, and it is necessary for us to explore its feasibility, appropriateness and effectiveness in practice. MethodsBased on the model of the integrated Promoting Action on Research Implementation in Health Services, we performed a four-phase implementation study in a tertiary hospital. The study was a non-randomized concurrent controlled trial design，and multilevel measures were examined including implementation outcomes and clinical outcomes. ResultsFor the implementation outcomes, the tailored recommendations of the guideline were found to be acceptable, appropriate, feasible, and well adopted both at the unit level and the hospital level. The clinical outcomes indicated that, compared with the control unit, nurses of the treatment unit performed better in awareness, knowledge, practice of WLBP prevention and care. ConclusionsThe implementation study supports the successful application of the guideline, which can serve as a valuable evidence-based document to improve back health of nursing personnel.

Impact of Optimizing Emergency Nursing Processes on Resuscitation Success in Patients with Acute Chest Pain

Impact of Optimizing Emergency Nursing Processes on Resuscitation Success in Patients with Acute Chest Pain

Clinical validation of the ineffective social support network nursing diagnosis in violence-victimized women.

To verify clinical validity evidence for the ineffective social support network nursing diagnosis. A quantitative, descriptive, cross-sectional study was performed with 98 violence-victimized women treated in two reference centers for violence in the city of Recife, Pernambuco, Brazil. The women were interviewed from August 2021 to June 2022. The clinical indicators that best predicted the nursing diagnosis were as follows: Frustration with unmet support expectations, negative social interaction, perceived neglect of support demands, feeling of abandonment, low reciprocity, and encouragement of negative behaviors. Etiological factors that showed greater association were excessive demand for support, limited social network, social isolation, the fragility of institutional service networked organizations, and inadequate appreciation of available social support. The clinical validity evidence for the ineffective social support network nursing diagnosis has been verified. Thus, the validated clinical indicators and etiological factors can accurately diagnose and predict the emergence of this phenomenon in violence-victimized women. The results contribute to advancing scientific knowledge in nursing teaching, research, and practice and support the nursing process in violence-victimized women.

The Grieving Process for Nurses: A Concept Analysis

Background: This study delved into the nuanced experience of grieving among nurses, shedding light on an essential yet often overlooked aspect of their professional and personal lives. Grief among nurses is a significant issue due to the frequent exposure to patient deaths and personal losses, which can profoundly impact their emotional and psychological well-being. Objective: The objective of this study was to employ a structured approach to conceptualize and elucidate the multifaceted nature of nurses' grief. The study aimed to identify defining attributes, antecedents, consequences, and empirical referents of nurses' grieving process, providing a comprehensive understanding to inform targeted interventions. Methods: This concept analysis used Walker and Avant's methodological framework, which includes eight steps: topic selection, establishing analysis goals, recognizing all possible uses of the concept, defining attributes, presenting a model case, identifying additional cases (e.g., borderline, contrary), determining antecedents and consequences, and describing empirical referents. A comprehensive literature review was conducted using databases such as PubMed, CINAHL, and PsycINFO. Data collection involved reviewing existing literature on the grieving process, emotional distress, burnout, self-care, and supportive interventions for nurses. The ethical principles outlined in the Declaration of Helsinki were followed, ensuring confidentiality and anonymity of all data sources. Results: The defining attributes of the grieving process for nurses included intense emotions (sadness, anger, guilt, depression), physical and emotional pain, and the unique demands of the nursing profession. Antecedents identified were personal loss and exposure to patient deaths, while consequences included emotional distress, impaired work performance, and increased stress. Empirical referents were measurable indicators such as the frequency of crying episodes, reports of physical symptoms, changes in work performance, and use of coping strategies. The analysis found that 85% of nurses experienced significant emotional distress, 70% reported impaired work performance, and 60% utilized some form of support or coping strategy. Conclusion: Understanding the grieving process among nurses is crucial for developing effective interventions and support systems. This study's findings underscore the importance of education, supportive interventions, self-care practices, and teamwork in promoting nurses' well-being and enhancing patient care outcomes. By providing a comprehensive understanding of nurses' grief, the study contributes valuable insights to nursing knowledge and practice, highlighting the need for targeted interventions to support nurses in coping with the emotional challenges of their profession.