Teaching Diagnostic Reasoning: A Review of Evidence-Based Interventions.

Problem/Background: The ability to accurately diagnose patients based on symptom profiles is a vital yet challenging skill that Nurse Practitioners (NPs) undertake frequently. PURPOSE: This integrative literature review highlights a variety of evidence based, practical educational strategies that foster the development of diagnostic reasoning. METHODS: An integrative literature review was conducted in order to identify original research focusing on diagnostic reasoning educational interventions. RESULTS: Eighteen primary sources met inclusion and exclusion criteria. Results are synthesized in terms of sample and setting, methodological features, interventions, and outcomes. Interventions broadly fit into five educational themes: testing strategies, cognitive biases, simulation programs, course formats, and instructional approaches. DISCUSSION: Interventions are simple and can be implemented in multiple educational settings. Future research should occur in populations of NP students. Validated, easy-to-use measurement tools as well as more precise diagnostic reasoning concept development should occur.

Validation of Clinical Indicators of the Nursing Diagnosis of Ineffective Protection in Adolescents With Cancer.

PURPOSE: To validate the clinical indicators of the nursing diagnosis of Ineffective protection in adolescents with cancer based on diagnostic accuracy measurements. DESIGN AND METHODS: Measurements of sensitivity and specificity for the indicators were calculated using latent class analysis with random effects in a sample of 127 adolescents between 10 and 19 years of age. RESULTS: The prevalence of diagnosis was estimated at 93.7%. The indicators deficient immunity and weakness showed higher sensitivity values, whereas opportunistic infections, recurrent infections, insomnia, mucosal lesions, and coughing showed high specificity. CONCLUSIONS: Seven indicators were clinically validated. PRACTICE IMPLICATIONS: The validation of clinical indicators provides nurses with the knowledge of useful signs and symptoms to identify early spectra of a nursing diagnosis or confirm their presence in a specific population. In clinical practice, this knowledge contributes to an accurate diagnostic inference and the planning of nursing interventions directed to the idiosyncrasies of individuals.

Classification of Patient Care Complexity: Cloud Technology.

Presentation of the computerized structure to implement, in a university hospital in the South of Brazil, the Patients Classification System of Perroca, which categorizes patients according to the care complexity. This solution also aims to corroborate a recent study at the hospital, which evidenced that the increasing workload presents a direct relation with the institutional quality indicators. The tools used were the Google applications with high productivity interconnecting the topic knowledge on behalf of the nursing professionals and information technology professionals.

Early Assessment of Patient's Medical Condition in Ambulance Care Affects the Level of Care of Non Urgent Patients.

The Rapid Emergency Triage and Treatment System (RETTS) is used by the Swedish ambulance care organization for assessment of patients medical condition. The aim of the present study was to evaluate prehospital assessment in collaboration with the ambulance nurse and primary health care physicians. If the patient's condition was priority GREEN by RETTS then the ambulance nurse decided to contact the primary care physicians for a dialogue and together they decided which level of care was the most appropriate for the patient's condition.

"Does one size fit all?" Exploring the cultural applicability of NANDA nursing diagnoses to Chinese nursing practice.

East Asia has historically unique concepts of health and well-being and thus is an appropriate setting for exploring the multicultural applicability of the North American Nursing Diagnosis Association's Nursing Diagnoses (NANDA ND) system. This study aimed to explore how NANDA ND affect the growth and quality of professional nursing from the perspective of Taiwanese nurses. Grounded theory was employed in this interview-based investigation of 53 Taiwan-licensed nursing professionals at various hospitals in Taiwan. Data were analyzed using constant comparative analysis until theoretical saturation was reached. The core concept, Struggling with (the NANDA ND notion that) One Size Fits All, emerged after ongoing analysis of the effects of NANDA ND on good nursing, patient welfare, and professional development. The preliminary theoretical framework developed from this study provides evidence that NANDA ND may be incompatible with the cultural beliefs of the traditional Chinese health care setting in Taiwan, which emphasize holistic harmony and balance.

Conceptualization of an electronic system for documentation of nursing diagnosis, outcomes, and intervention.

Electronic nursing documentation constitutes technical, scientific, legal, and ethical documents. The objective of this study was to develop an electronic nursing documentation system. The system was developed in four phases (conceptualization, detailing, prototype building, implementation), and the knowledge base was based on domains and classes according to the NANDA-I, NIC, and NOC unified framework. The result is an electronic system (PROCEnf--USP--Nursing Process Electronic Documentation System of the University of São Paulo) which allows documenting nursing process generating reports of nursing process, besides supporting decisions on nursing diagnosis, expected outcomes, and interventions. Integration of different fields of knowledge, as well as the institutional feature of valuing continuous theoretical and practical improvement of nursing process were factors of success of this technological project.

An analysis of nursing diagnoses for patients undergoing procedures in a Brazilian interventional radiology suite.

Innovations in minimally invasive surgery have led to more procedures being performed in the interventional radiology suite. It, therefore, is essential that nurses in radiology departments be competent to care for all types of patients. Use of nursing classification systems can improve care by providing standardized language for documentation. We conducted a project that involved 25 patients undergoing interventional radiology procedures between August and October 2006 in São Paulo, Brazil, to identify the most frequent North American Nursing Diagnosis Association (NANDA) nursing diagnoses used and then compared the NANDA diagnoses to Perioperative Nursing Data Set diagnoses. The most frequent nursing diagnoses in the participants were anxiety, chronic pain, inefficient tissue perfusion-peripheral, deficient knowledge, and risk for falls. These results are similar to diagnoses that have been reported in outpatient centers. The NANDA and Perioperative Nursing Data Set diagnoses were found to be similar.

Nurses' responses to differing amounts and information content in a diagnostic computer-based decision support application.

Nurses often need to make quick decisions with incomplete diagnostic information while they are under time pressure. The use of a data-driven, computerized decision support approach in daily work activities has great potential to facilitate precise and context-sensitive use of the information implicit in nursing diagnoses. This study explored optimal information amounts and levels of information content for designing and implementing a diagnostic nursing decision support system. Specifically, the use of probability data for likely nursing problems and the preferred number of displayed nursing problems were presented to expert and novice nurses. The study used a counterbalanced, repeated-measures, and factorial design. The authors developed two scenarios: (1) a pneumonia patient with diabetes mellitus complications and (2) a patient with controlled diabetes who also had a bone fracture. A previously developed prototype for a diagnostic nursing decision support system was used to display the information. Eighteen novice and expert nurses from two hospitals in Korea participated. Results for the differing levels of content did not differ significantly with level of expertise, but the preferred amount of information was significant for the two groups of nurses. The differing information needs of novices and experts should be considered when designing future computer-based decision support.

Diseño e implementación del sistema de información para la relación docencia-servicio del programa de enfermería en la Universidad Libre de Pereira / Design and implementation of information system for teaching-service relationship of the nursing program at the Universidad Libre of Pereira

Objetivo: Presentar la metodología empleada en el diseño del sistema de información para la relación docencia-servicio, según el acuerdo 003 de 2003 y describir los resultados de su implementación en el primer semestre de 2008. Metodología: Se construyeron indicadores a partir de los criterios de evaluación para cada una de los factores y características del acuerdo. Se definieron los subsistemas de gestión y operación y la información generada de las unidades básicas: convenio, acta de reunión de la relación docencia-servicio, evaluación y costos y suministros. Resultados: El 100 de los convenios se realizó con instituciones que tenían certificación y habilitación y se elaboraron siguiendo los criterios del modelo docencia-servicio. Se realizaron comités al inicio del semestre, en el 100 de los convenios realizados. El 37,5, de los usuarios atendidos por los estudiantes fueron adultos jóvenes, el 18,0 niños menores de 10 años y adultos mayores, el 10,4. Los diagnósticos enfermeros más frecuentes fueron: el riesgo de infección, el dolor agudo y el deterioro de la movilidad física. El 36,6 de los procedimientos de enfermería fueron administrativos el 39,8, clínicos y el 23,6 de tipo ambulatorio y comunitario. Conclusiones: El diseño del sistema de información para la relación docencia-servicio ha sido útil para realizar su seguimiento desde el orden gerencial y operativo y en el proceso de toma de decisiones referente al proceso educativo de los estudiantes de enfermería durante sus prácticas formativas.

Objective: To present the methodology used in designing the information system for teaching-service relationship, according to the agreement 003 of 2003 and describing the results of its implementation in the first semester of 2008. Methodology: Indicators were constructed upon the evaluation criteria for each of the factors and features of the agreement. Management and operational subsystems were defined and the information generated from the basic units: agreement, minutes of meeting of the Teaching-service relationship, evaluation, costs and supplies. Results: 100 of the agreements were made with institutions with certification and accreditation and developed using the criteria of teaching-service model. Committees were made at the beginning of the semester, in the 100 of the agreements. 37.5 of users assisted by the students were young adults, 18.0 children under age 10 and 10.4 senior adults. The most frequent nursing diagnoses were: the risk of infection, acute pain and impaired physical mobility. The 36.6 of the nursing procedures were administrative, 39.8 clinical and 23.6 of outpatient and community patients. Conclusions: The design of follow up system for teaching-service relationship has been useful for tracking of the managerial and operational command and the decision making process, relating to the education of nursing students during their internship.

Examination of nursing diagnoses used by nursing students and their opinions about nursing diagnoses.

PURPOSE: This study was planned as a descriptive study for the purpose of determining what nursing diagnoses are used by nursing students and their opinions about nursing diagnoses. METHODS: The response rate was 70% (n= 346). Research data about the nursing diagnoses students used and their opinions about them were collected on a semi-structured questionnaire developed by the researchers after reviewing related information in the literature. FINDINGS: Of the students, 76.9% knew what nursing diagnosis was, but 31.5% had difficulty stating patient care needs as nursing diagnoses. CONCLUSIONS: The majority of students in this study agreed that nursing diagnoses are a priority subject in the nursing profession, that nursing diagnoses needed to be used on the wards, and that nursing diagnoses needed to be documented in medical records on the wards. IMPLICATIONS FOR NURSING PRACTICE: It is recommended that nursing diagnoses be given more concentration in the nursing curriculum and that courses about nursing diagnoses be prepared for the purpose of giving students more detailed information.

Contamination: concept analysis and nursing implications.

PURPOSE: To analyze the concept of contamination and discuss the implications for nursing practice, research, and education. DATA SOURCES: Published research articles, official governmental publications, policy reports, and textbooks. DATA SYNTHESIS: Various attributes of contamination are described using the Walker and Avant method of concept analysis and include: (a) exposure to a contaminant, and (b) contaminant exists in a dose sufficient to cause adverse health effects. The major antecedents of contamination include the presence of a contaminant, dose, duration of exposure, route of exposure, and individual human differences. Major consequences of contamination include organ and systemic responses, and psychological, social, and economic effects. CONCLUSIONS: Contamination is an important concept and is essential to the discipline of nursing. The concept of contamination is separate from exposure. Precision in the use of diagnostic language describing contamination incidents will lead to greater accuracy in outcomes and interventions for individuals and groups experiencing overt or covert contamination resulting from accidental or intentional acts. Broad agreement on the definition, antecedents, and consequences of contamination will improve the likelihood of successful management of contamination events. IMPLICATIONS: The nursing profession makes an important contribution to the improvement of individual, community, and societal environmental health. Clarifying the concept of contamination is an important first step in building the nursing science that will lead to identifying sound nursing interventions.

Implementation of standardized nomenclature in the electronic medical record.

PURPOSE: To describe a customized electronic medical record documentation system which provides an electronic health record, Epic, which was implemented in December 2006 using standardized taxonomies for nursing documentation. DATA SOURCES: Descriptive data is provided regarding the development, implementation, and evaluation processes for the electronic medical record system. Nurses used standardized nursing nomenclature including NANDA-I diagnoses, Nursing Interventions Classification, and Nursing Outcomes Classification in a measurable and user-friendly format using the care plan activity. CONCLUSIONS AND IMPLICATIONS: Key factors in the success of the project included close collaboration among staff nurses and information technology staff, ongoing support and encouragement from the vice president/chief nursing officer, the ready availability of expert resources, and nursing ownership of the project. Use of this evidence-based documentation enhanced institutional leadership in clinical documentation.

Case study: the challenges of self-management of exacerbation of pulmonary symptoms.

PURPOSE: This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self-management for a female veteran. DATA SOURCES: Data were obtained through the author's clinical practice in primary care nursing and research literature sources. DATA SYNTHESIS: The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSIONS: This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations. IMPLICATIONS FOR NURSING PRACTICE: Employing the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis capture nursing practice? A Delphi survey.

BACKGROUND: The "Comprehensive ICF Core Set for Rheumatoid Arthritis (RA)" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA. OBJECTIVES: The objective of this study was to validate this ICF Core Set from the perspective of nurses. METHOD: Nurses experienced in RA treatment were asked about the patients' problems, patients' resources and aspects of environment that nurses take care of in a three-round survey using the Delphi technique. Responses were linked to the ICF. RESULTS: 57 nurses in 15 countries named 1170 concepts that covered all ICF components. 20 concepts were linked to the as yet undeveloped ICF component Personal Factors. 19 ICF categories are not represented in the Comprehensive ICF Core Set for RA. CONCLUSION: The validity of the Comprehensive ICF Core Set for RA was largely supported by the nurses. However, a number of body functions which address side effects of drug therapies were not included in the Comprehensive ICF Core Set for RA. Furthermore, several issues arose which were not precisely covered by the ICF like "dry mucous", "risk for decubitus ulcers" and "height" and need to be investigated further.