[Design of a nursing assessment instrument during pregnancy monitoring in Primary Health care and the validation of its content]. / Diseño de un instrumento de valoración enfermera para el seguimiento de embarazo en Atención Primaria de salud y la validación de su contenido.

OBJECTIVE: This research aims to develop a nursing assessment tool, based on Gordon's Health Functional Patterns, through a content validation by a committee of experts, applying a Delphi technique. DESIGN: An assessment instrument with 53 items has been designed. SITE: It is carried out within the framework of a doctoral thesis, for its implementation by midwives of Primary Health Care. PARTICIPANTS: The committee was made up of 16 professionals with a hide clinical, teaching and research experience who all participated in the entire validation process. INTERVENTION: It has been assessed as a whole and in each of the items through four rounds of consultations, establishing a positive assessment of more than 60% to accept each item, as well as incorporating the suggestions provided by the committee. The final version had to reach a unanimous consensus. MAIN MEASUREMENTS: All items were accepted with a score higher than 60%. RESULTS: There were no contradictions between the inputs provided by the experts, so all of them were integrated into the final version that has a 100% approval by the committee. CONCLUSION: After this process, a new assessment tool is presented to be applied by primary care midwives in the pregnancy monitoring. The questionnaire has been piloted with 50 pregnant women, determining the most prevalent nursing diagnoses, establishing the workload for the midwife of her implementation of individualized care plans to improve some health indicators of pregnant women.

Construction and validation of a risk-prediction model for chemotherapy-related cognitive impairment in patients with breast cancer.

PURPOSE: To identify risk factors of chemotherapy-related cognitive impairment (CRCI) and construct and validate a visual prediction model of such for patients with breast cancer. METHODS: A multicenter, descriptive, and cross-sectional design was adopted. Data were collected from ten public tertiary hospitals in China. Cognitive function was assessed by using Functional Assessment of Cancer Therapy-cognitive function. Socio-demographic, clinical, psychological, and physical indicators were also assessed. The logistic prediction model was constructed by fivefold cross-validation. Then, a nomogram was utilized to visualize the prediction model, which was also evaluated via discrimination, calibration, and decision curve analysis. RESULTS: A total of 71 breast cancer patients had CRCI with a prevalence of 9.58%. This visual prediction model was constructed based on education background, exercise frequency, chemotherapy times, and fatigue and demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.882. The calibration curve indicated good agreement between experimental and projected values, and the decision curve proved good clinical applicability. CONCLUSION: Education background, exercise frequency, chemotherapy times, and fatigue were associated with high incidence of CRCI. The prediction model exhibits superior performance and has promise as a useful instrument for assessing the likelihood of CRCI in breast cancer patients. IMPLICATIONS FOR CANCER SURVIVORS: Our findings could provide breast cancer survivors with risk screening based on CRCI predictors to implement prevention and early intervention, and help patients integrate into society and achieve comprehensive recovery.

Nursing assessment and care for a patient with a neurological disorder.

The previous article discussed the pathophysiology involved in disorders of the nervous system. Having considered some of the most prevalent disorders, this second part uses a case study to explore effective patient assessment and emphasise the importance of facilitating patient self-management for improved outcomes. By addressing these key aspects, nursing professionals can enhance the quality of care and the support provided to individuals experiencing neurological disorders.

Construction of a nursing assessment framework for patients in anaesthesia recovery period: A modified Delphi study.

AIM: To construct a nursing assessment framework for patients in anaesthesia recovery period. DESIGN: A three-round modified Delphi method was employed to capture the consensus of 22 panellists. METHODS: The initial items in the nursing assessment framework for patients in anaesthesia recovery period were developed based on the mini-clinical evaluation exercise (mini-CEX). A panel of 22 experts participated in this study. The panellists have more than 10 years of experience in either clinical anaesthesia, or post-anesthesia nursing, or operating room nursing, or surgical intensive nursing. Between March and April 2023, the panellists evaluated and recommended revisions to the initial framework. RESULTS: This study resulted in the development of a nursing assessment framework for patients in anaesthesia recovery period. The initial version of the framework consisted of six dimensions with 27 items. Six items were modified after the first round of consultation. After the second round, five modifications and four deletions were made based on expert opinion. The third round resulted in a convergence of expert opinion. The framework, which consists of 24 items across five dimensions, was refined. The five dimensions are as follows: History-taking, Physical assessment, Clinical judgement, Organizational efficiency and Humanistic concern. CONCLUSION: The nursing assessment framework for patients in anaesthesia recovery period was reached consensus between the 22 experts' opinions. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The assessment framework constructed in this study could be used for the process evaluation of post-anesthesia nursing. The framework may guide perianesthesia nurses in the timely and effective assessment of patients during this critical phase of care. It may be used for perianesthesia nursing education or to evaluate nurses' assessment skills. REPORTING METHOD: The study is reported in accordance with the Guidance on Conducting and Reporting DElphi Studies (CREDES) recommendations. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Importance of specific vital signs in nurses' recognition and response to deteriorating patients: A scoping review.

AIM(S): To explore the published research related to nurses' documentation and use of vital signs in recognising and responding to deteriorating patients. DESIGN: Scoping review of international, peer-reviewed research studies. DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature Complete, Medline Complete, American Psychological Association PsycInfo and Excerpta Medica were searched on 25 July 2023. REPORTING METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. RESULTS: Of 3880 potentially eligible publications, 32 were included. There were 26 studies of nurses' vital sign documentation: 21 adults and five paediatric. The most and least frequently documented vital signs were blood pressure and respiratory rate respectively. Seven studies focused on vital signs and rapid response activation or afferent limb failure. Five studies of vital signs used to trigger the rapid response system showed heart rate was the most frequent and respiratory rate and conscious state were the least frequent. Heart rate was least likely and oxygen saturation was most likely to be associated with afferent limb failure (n = 4 studies). CONCLUSION: Despite high reliance on using vital signs to recognise clinical deterioration and activate a response to deteriorating patients in hospital settings, nurses' documentation of vital signs and use of vital signs to activate rapid response systems is poorly understood. There were 21studies of nurses' vital sign documentation in adult patients and five studies related to children. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: A deeper understanding of nurses' decisions to assess (or not assess) specific vital signs, analysis of the value or importance nurses place (or not) on specific vital sign parameters is warranted. The influence of patient characteristics (such as age) or the clinical practice setting, and the impact of nurses' workflows of vital sign assessment warrants further investigation. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Nursing standards, language and age as variables associated with clinical competence for nurses in long-term care facilities: A cross-sectional study.

AIM: To identify and examine the explanatory variables associated with clinical competence among registered nurses (RNs) and practical nurses (PNs) working in long-term care facilities (LTCF) for older adults. DESIGN AND METHODS: This was a cross-sectional study. The competence test, 'the Ms. Olsen test', was used for data collection. A convenience sample of 337 nursing staff working in LTCFs for older adults was selected between December 2020 and January 2021. A quantitative, non-experimental approach with multiple linear regression analysis examined the explanatory variables associated with clinical competence and the outcome variables. RESULTS: The main findings of the linear regression analysis show that the nursing staff's increasing age, use of Swedish as a working language and use of the Finnish nursing practice standards had statistically significant relationships with clinical competence among the participating nursing staff. CONCLUSION: This is the first knowledge test that has been developed to test nursing staff's clinical competence in elderly care. In this study in Finland, the highest clinical competence was among the nursing staff who were Swedish-speaking RNs working in institutional care homes caring for patients according to national practice standards. IMPLICATIONS: These results may be useful to nursing staff and managers working in elderly care to understand the explanatory variables associated with clinical competence in elderly care in Finland and in bilingual settings. The study highlights the importance of using national nursing standards in elderly nursing care. Knowing the explanatory variables associated with clinical competence can provide guidance for the further education of nursing staff in these settings. IMPACT: Caring according to national practice standards and caring for severely ill patients are associated with clinical competence. REPORTING METHOD: The authors adhered to the EQUATOR network guidelines Appendix S1 STROBE to report observational cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: Registered and PNs completed a questionnaire for the data collection.

What influences the inclusion of skin tone diversity when teaching skin assessment? Findings from a survey.

BACKGROUND: Understanding the variances in visual skin changes across all skin tones is important in clinical care. However, the experiences of those teaching skin assessment to pre- and post-registrant nurses are unknown. AIMS: To determine the barriers and facilitators experienced in teaching skin assessment across a range of skin tones to pre- and post-registrant nurses. METHODS: A cross-sectional, mixed-methods online survey was undertaken throughout February and March 2023 based on the Theoretical Domains Framework of behaviour change. FINDINGS: In this self-selecting sample, most participants were aware of why it was important to include all skin tones when teaching skin assessment and were professionally motivated to include this in their practice. However, resources and support are needed to overcome an unconscious bias in teaching skin tone diversity, resulting in a lack of availability of good quality photographs and educator confidence in their own skills. Educators not considering skin tone when selecting patient cases and relying on people with dark skin tones to highlight where practice is not inclusive may also lead to insufficient exposure for students. CONCLUSION: There is some awareness of the importance of including diverse skin tones in teaching, but further education and resources are needed.

The nervous system and associated disorders.

Disorders of the nervous system, encompassing the brain, spinal cord and peripheral nerves, have emerged as a significant public health issue, with profound implications for individuals worldwide. These conditions result in significant morbidity and mortality. Many patients with neurological disorders often have comorbidities, further complicating their clinical presentation. Therefore, nurses must possess a comprehensive understanding of the nervous system and its associated disorders to formulate detailed care plans that address the unique needs of each patient. This article aims to explore the underlying pathophysiology of some of the most prevalent neurological disorders and how this informs effective patient assessment and diagnostic strategies. A further article will build on this to consider patient assessment and formulating a care plan in more detail.

The Effect of Modified Early Warning Score (MEWS) and Nursing Guide Application on Postoperative Patient Outcomes: A Randomized Controlled Study.

PURPOSE: The aim of this study is to determine the effect of nursing guide application (NGA) on patient outcomes in patients followed up according to the modified early warning score (MEWS) in the postoperative period. DESIGN: A randomized controlled clinical trial. METHODS: The sample of the study consisted of 252 patients who underwent surgical intervention under general anesthesia in a university hospital between July 29, 2022, and October 31, 2022. FINDINGS: Results showed that the development of complications was less in the study group (SG) compared to the control group (CG) during anesthesia (P = .027), in the postanesthesia care unit (PACU) (P = .017), and in the clinic (P = .001). It was found that the duration of stay in PACU in the CG was significantly shorter than in the study group (P < .001), and as the duration of stay in PACU in CG decreased, the MEWS increased (r = -0.201, P = .024). We found that there were fewer patients transferred to the intensive care unit (ICU) after PACU (P = .007), the MEWS was lower, and the number of nursing interventions applied to patients was higher (P < .05). CONCLUSIONS: In patients followed up according to MEWS, NGA had a positive effect on preventing the development of complications and shortening the intervention time for complications, decreasing ICU admission, decreasing MEWS and increasing the number of nursing interventions. Based on the results, it may be recommended to use MEWS+NGA in the early postoperative period as it positively affects patient outcomes.

Transforming nursing assessment in acute hospitals: A cluster randomised controlled trial of an evidence-based nursing core assessment (the ENCORE trial).

BACKGROUND: Patient safety is threatened when early signs of clinical deterioration are missed or not acted upon. This research began as a clinical-academic partnership established around a shared concern of nursing physical assessment practices on general wards and delayed recognition of clinical deterioration. The outcome was the development of a complex intervention facilitated at the ward level for proactive nursing surveillance. METHODS: The evidence-based nursing core assessment (ENCORE) trial was a pragmatic cluster-randomised controlled trial. We hypothesised that ward intervention would reduce the incidence of patient rescue events (medical emergency team activations) and serious adverse events. We randomised 29 general wards in a 1:2 allocation, across 5 Australian hospitals to intervention (n = 10) and usual care wards (n = 19). Skilled facilitation over 12 months enabled practitioner-led, ward-level practice change for proactive nursing surveillance. The primary outcome was the rate of medical emergency team activations and secondary outcomes were unplanned intensive care unit admissions, on-ward resuscitations, and unexpected deaths. Outcomes were prospectively collected for 6 months following the initial 6 months of implementation. Analysis was at the patient level using generalised linear mixed models to account for clustering by ward. RESULTS: We analysed 29,385 patient admissions to intervention (n = 11,792) and control (n = 17,593) wards. Adjusted models for overall effects suggested the intervention increased the rate of medical emergency team activations (adjusted incidence rate ratio 1.314; 95 % confidence interval 0.975, 1.773), although the confidence interval was compatible with a marginal decrease to a substantial increase in rate. Confidence intervals for secondary outcomes included a range of plausible effects from benefit to harm. However, considerable heterogeneity was observed in intervention effects by patient comorbidity. Among patients with few comorbid conditions in the intervention arm there was a lower medical emergency team activation rate and decreased odds of unexpected death. Among patients with multimorbidity in the intervention arm there were higher rates of medical emergency team activation and intensive care unit admissions. CONCLUSION: Trial outcomes have refined our assumptions about the impact of the ENCORE intervention. The intervention appears to have protective effects for patients with low complexity where frontline teams can respond locally. It also appears to have redistributed medical emergency team activations and unplanned intensive care unit admissions, mobilising higher rates of rescue for patients with multimorbidity. TRIAL REGISTRATION NUMBER: ACTRN12618001903279 (Date of registration: 22/11/2018; First participant recruited: 01/02/2019).

Patients' experiences of day surgery and recovery: A meta-ethnography.

AIM: To explore and synthesise findings from qualitative studies on adult patients' experiences of day surgery and the processes of recovery. BACKGROUND: There has been a shift in the practice of elective surgery, from inpatient to ambulatory treatment. Accordingly, more patients are undergoing day surgery and expected to care for themselves at home. To our knowledge, an updated metasynthesis on patients' experiences of day surgery across diverse contexts and continents is lacking. DESIGN: Meta-ethnography. METHODS: MEDLINE, EMBASE and CINAHL were systematically searched for qualitative research in English published between 2006 and 2023. Noblit and Hare's meta-ethnographic approach guided the synthesis of findings from 12 qualitative studies, and the eMERGe Reporting Guidance was used in the writing of this article. RESULTS: Four themes were revealed: (1) requests for tailored information, (2) challenges of recognising and understanding postoperative symptoms, (3) being dependent on continuous professional and personal support and (4) calling for individual adaptation. CONCLUSION: Our meta-ethnography indicates there is a need to improve information provision to better prepare patients for the processes of day surgery and recovery and promote their self-care abilities. Our findings highlight the importance of ensuring adequate levels of individualised care and support throughout the treatment process. RELEVANCE TO CLINICAL PRACTICE: To improve quality of care in day surgery practice, implementation of interventions to enhance information provision and promote self-care during recovery at home may be considered. Pre-admission appointments that incorporate provision of tailored information and assessment of the patients' individual needs of care and support, home conditions and access to assistance from family/friends can be recommended.

Using the Analytic Hierarchy Process to Measure Nurses' Decision-Making Regarding Fall Risks and Care Strategies for Fall Prevention.

Background and Purpose: Visualizing the thought processes of nurses is useful in forming evidence to prevent falls. This study aimed to quantify nursing judgment by comparing the choices made by nurses with different experiences regarding fall prevention. Methods: Questionnaires were administered to participants with <9 and ≥10 years of nursing experience to examine their importance ratings regarding fall prevention using an analytic hierarchy process (AHP). Results: Compared with the group with <9 years of experience, the group with ≥10 years of experience viewed habitual behavior in unstable activity as the most important fall risk. They also viewed early detection and alleviation of symptoms that lead to fall risk due to side effects of drugs and diseases as an important nursing practice. Conclusion: Since differences in nursing judgment between experienced and inexperienced nurses were revealed, it is possible that nursing judgment can be measured using AHP.

Facilitating Gender-Affirming Nursing Encounters.

The purpose of this article is to highlight the essentials for facilitating gender-affirming nursing encounters for transgender, nonbinary, and other gender expansive (TNGE) people. The authors illustrate what constitutes as gender-affirming nursing encounters by characterizing gender-affirming approaches to conducting and documenting a nursing assessment and describing techniques to overcome institutional-level challenges that may hinder a nurse's ability to establish gender-affirming therapeutic relationships with TNGE people. The authors also provide strategies that nurses can use to improve their health care organization and interprofessional collaborative practice to create psychologically and physically safe health care spaces for TNGE people.

A School Nurse's Experience With Supraventricular Tachycardia.

Students visit school health offices with a variety of complaints, and while some may be minor, others may be more pressing. The challenge for the school nurse is being able to differentiate between the two. This article features a case study of a fourth-grade elementary student who presented to the school nurse with a sudden onset of supraventricular tachycardia (SVT), a rapid cardiac arrhythmia that originates above the ventricles in the heart. The student's complaint was a "racing heart," and it was her first time experiencing a cardiac episode. It was also the school nurse's first time encountering this chief complaint. The article will describe the student's presentation to the health office, will discuss the school nurse's assessments along with SVT management techniques, and will conclude with the student's outcome and a sample individualized healthcare plan.

Psychometric evaluation of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version / Evaluación psicométrica del instrumento Functional Health Pattern Assessment Screening Tool - Versión modificada para Brasil / Avaliação psicométrica do Functional Health Pattern Assessment Screening Tool - Versão Brasileira Modificada

Objective: to test the factorial structure, reliability and convergent validity of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version. Method: this was a psychometric evaluation of the Functional Health Pattern Assessment Screening Tool - Modified Brazilian Version. Seven hundred and seventeen participants answered the data collection instrument consisting of two parts. Part I included a structured questionnaire to collect sociodemographic data and the participants' perceptions and satisfaction with their current health status. Part II consisted of the tool being tested. The internal structure was assessed using Confirmatory Factor Analysis. Convergent validity was evaluated by the correlation of the tool scores with the rates corresponding to self-perception and satisfaction with current health status. Reliability was assessed using Cronbach's alpha. Results: the Confirmatory Factor Analysis confirmed a three-factor solution. The factor loadings were significant and varied from 0.16 to 0.75; the fit indices suggested moderate fit of the model. Internal consistency for all three components varied between 0.779 and 0.919. Conclusion: the findings suggest that the tool is valid and reliable to be used in the Brazilian population, although caution is recommended when interpreting the results due to the moderate fit of the model.

Objetivo: someter a prueba la estructura factorial, confiabilidad y validez convergente del instrumento Functional Health Pattern Assessment Screening Tool - Versión modificada para Brasil. Método: evaluación psicométrica del instrumento Functional Health Pattern Assessment Screening Tool - Versión modificada para Brasil. Setecientos diecisiete participantes respondieron el instrumento de recolección de datos, compuesto por dos partes. La Parte I incluyó un cuestionario estructurado para recopilar datos sociodemográficos y las percepciones y el nivel de satisfacción de los participantes con respecto a su estado de salud actual. La Parte II consistió en la herramienta sometida a prueba. La estructura interna se evaluó empleando Análisis Factorial Confirmatorio. La validez interna se evaluó por medio de la correlación entre las puntuaciones obtenidas en la herramienta y los índices correspondientes a los niveles de autopercepción y satisfacción con respecto al estado de salud actual. La confiabilidad se evaluó utilizando el coeficiente alfa de Cronbach. Resultados: el Análisis Factorial Confirmatorio confirmó una solución con tres factores. Las cargas factoriales fueron significativas y variaron entre 0,16 y 0.75; los índices de ajuste sugirieron ajuste moderado del modelo. La consistencia interna correspondiente a los tres componentes varió entre 0,779 y 0,919. Conclusión: los hallazgos sugieren que la herramienta es válida y confiable para ser usada en la población de Brasil, aunque se recomienda interpretar los resultados con precaución debido al moderado ajuste del modelo.

Objetivo: testar a estrutura fatorial, a confiabilidade e a validade convergente do Functional Health Pattern Assessment Screening Tool - Versão Brasileira Modificada. Método: avaliação psicométrica do Functional Health Pattern Assessment Screening Tool - Versão Brasileira Modificada. Setecentos e dezessete participantes responderam os itens do instrumento de coleta de dados composto por duas partes. A Parte I incluiu um questionário estruturado contendo dados sociodemográficos e a percepção e satisfação dos participantes com seu estado de saúde atual. A Parte II consistiu no instrumento testado. A estrutura interna foi avaliada por meio de Análise Fatorial Confirmatória. A validade convergente foi avaliada pela correlação dos escores do instrumento com os índices correspondentes à autopercepção e à satisfação com o estado de saúde atual. A confiabilidade foi avaliada pelo alfa de Cronbach. Resultados: a Análise Fatorial Confirmatória confirmou uma solução de três fatores. As cargas fatoriais foram significativas e variaram de 0,16 a 0,75; os índices de ajuste sugeriram ajuste moderado do modelo. A consistência interna dos três componentes variou entre 0,779 e 0,919. Conclusión: os achados sugerem que o instrumento é válido e confiável para ser utilizado na população brasileira, embora seja recomendada cautela na interpretação dos resultados devido ao ajuste moderado do modelo.

Exploring the effects of extended reality head-mounted display nervous system assessment training for nursing students: A pilot feasibility study.

BACKGROUND: Health assessment is crucial for planning nursing interventions. Specifically, cerebrovascular diseases involve rapid neurological changes that necessitate precise hands-on assessment skills training. OBJECTIVES: This study developed and implemented an extended reality head-mounted display (HMD) nervous system assessment training program for nursing students to identify the usability and effectiveness of the system by analyzing their experiences. DESIGN: This was a mixed-methods study that combined the quantitative element of a one-group pre-post-test design with the qualitative element of qualitative content analysis. SETTING: University in Korea. PARTICIPANTS: The study involved 36 nursing students in their 4th year who completed classes in health assessments and adult nursing (nervous system). METHODS: An extended reality nervous system assessment training program was developed using the National Institutes of Health Stroke Scale and limb strength assessment. The learners wore HMD and received training at their own pace. System usability, confidence in nervous system assessment, learning satisfaction, and performance ability were measured and analyzed using SPSS Windows software version 28.0. Descriptive data were used for qualitative content analysis of the training experience. RESULTS: The usability of the extended-reality HMD nervous system assessment training received positive feedback and most participants (94.4 %) agreed with the system's consistency. Confidence in nervous system assessment significantly improved after the training (p < .001). After the training, learning satisfaction and performance ability were high. Furthermore, advantages of XR-based learning devices and positive learning were observed. Nonetheless, issues such as difficulties in operating the device, inconvenience, physical side effects of wearing the device, and technical limitations existed. CONCLUSIONS: This study developed and implemented an extended-reality HMD nervous system assessment training program to confirm its feasibility. However, challenges regarding device utilization need to be resolved for its effective development as a learning tool.

Design and implementation of an automatic nursing assessment system based on CDSS technology.

BACKGROUND: Various quantitative and quality assessment tools are currently used in nursing to evaluate a patient's physiological, psychological, and socioeconomic status. The results play important roles in evaluating the efficiency of healthcare, improving the treatment plans, and lowing relevant clinical risks. However, the manual process of the assessment imposes a substantial burden and can lead to errors in digitalization. To fill these gaps, we proposed an automatic nursing assessment system based on clinical decision support system (CDSS). The framework underlying the CDSS included experts, evaluation criteria, and voting roles for selecting electronic assessment sheets over paper ones. METHODS: We developed the framework based on an expert voting flow to choose electronic assessment sheets. The CDSS was constructed based on a nursing process workflow model. A multilayer architecture with independent modules was used. The performance of the proposed system was evaluated by comparing the adverse events' incidence and the average time for regular daily assessment before and after the implementation. RESULTS: After implementation of the system, the adverse nursing events' incidence decreased significantly from 0.43 % to 0.37 % in the first year and further to 0.27 % in the second year (p-value: 0.04). Meanwhile, the median time for regular daily assessments further decreased from 63 s to 51 s. CONCLUSIONS: The automatic assessment system helps to reduce nurses' workload and the incidence of adverse nursing events.