Physical restraint intervention in the intensive care unit: An observational pilot study.

PURPOSE: Physical restraint (PR) is applied for patients' safety and to prevent the removal of inserted devices. No matter how well applied, PR causes undesired effects and discomfort to patients. Because PR-Guidelines are not yet implemented in Turkey, an observational study was performed to get baseline data on the type and number of PR-activities and on patients' complications in intensive care unit (ICU) patients. METHODS: An observational pilot study was conducted in anesthesia and reanimation adult ICUs in a midsized general hospital in Turkey. Included were 31 patients and two data collection tools: a basic form (patient demographics, medical information, and complications) and a PR observation guide on nurses' PR-activities. Descriptive statistics (frequencies, percentages, and mean and standard deviation) were used for data evaluation. FINDINGS: Most patients (61.3%) were male, and 74.2% were aged 60-79 years. Almost a third was unconscious (Glasgow Coma Scale <9) and at risk for falling. Of the total 33 activities of the Nursing Interventions Classification (NIC), 13 were never applied in 33% of patients. The most applied activity was "provide sufficient staff to assist with the safe application of physical restraining devices or manual restraints" (96.8%). Least applied were "explain inpatient and significant others the behaviors necessary for the termination of the intervention," "Provide the dependent patient with a means of summoning help" (6.5%), and "Teach family the risks and benefits of restraint reduction" (3.2%). Overall, 58.1% of patients had PR complications. CONCLUSIONS: For the first time, PR NIC activities were evaluated in a Turkish ICU. Findings show low performance of NIC activities and a high complication rate. IMPLICATIONS FOR NURSING PRACTICE: The findings provide the basis to implement a PR-Guideline in Turkish ICUs to enhance patients' safety and comfort.

"Eat Enough"-A nurse-led intervention to enhance hospitalized older adults' protein and energy nutrition.

PURPOSE: To develop an intervention enhancing hospitalized older adults' nutrition. METHODS: For the first time, a mixed-methods design with data triangulation was applied according to the six-step model of Corry et al. to elaborate on a complex nursing intervention in the form of a logic model. Patients who were aged ≥80 years and hospitalized for at least 5 days were included. Sample size for quantitative practice analysis was 135 older adults, whereas 22 older inpatients participated in interviews and observations for needs analysis and generated data for key principles. FINDINGS: The intervention "Eat Enough" encompasses nursing team culture and comprises six actionable targets to deliver needs-based support and reach required protein and energy intake for hospitalized older adults by sensitizing nurses and the interprofessional team. Facilitating nutritional intake would be supported by an advanced practice nurse who considers the medical and nursing care plan and therapy. CONCLUSIONS: The intervention "Eat Enough" demonstrates that nurses play a key role in interprofessional teams to enhance older adults' nutrition in hospital. The pipeline model displays how the actionable targets can be achieved, and how awareness raising can influence the context-leading to raised calories and protein requirement coverages and shorter length of stay. IMPLICATIONS FOR CLINICAL PRACTICE: By identifying risk factors of malnutrition and strengthening nurses' responsibilities, the intervention "Eat Enough" could significantly enhance nutrition among hospitalized older adults. However, the logic model should be tested and implemented in future research.

The quality of nursing diagnoses, interventions, and outcomes in Romanian nursing documentation measured with the Q-DIO: A cross-sectional study.

PURPOSE: To assess the quality of the nursing process in Romania by evaluating nursing documentations with the quality of diagnoses, interventions and outcomes (Q-DIO) measurement instrument. METHODS: A quantitative cross-sectional research design was employed using probabilistic sampling to select nursing documentations from a Romanian university hospital. The data were analyzed using the Q-DIO measurement instrument. FINDINGS: Low quality levels of nursing process documentation were found. The Q-DIO subscale "Nursing diagnoses as process" (assessment) revealed a mean = 1.36 (SD 0.52) of maximum 2. Nurses collected lots of data but did not use these to state nursing diagnoses. "Nursing diagnoses as product" showed inaccurate diagnoses; mean = 1.24 (SD 0.48) of maximum 4. Nursing interventions were planned and documented, but their impact on the etiology of nursing diagnoses was low; mean = 0.76 (SD 0.18). The quality of nursing outcomes mean was 0.57 (SD 0.29). Nurses failed making connections between nursing assessment, diagnoses, interventions, and outcomes, and standardized nursing languages (SNLs) were not used. Statistically significant differences were found among all Q-DIO sub-concepts except for "Nursing diagnoses as process." CONCLUSIONS: The documentation was structured but did not support the nursing process and its documentation, and SNLs were not implemented. There was an underutilization of data to state nursing diagnoses, and nursing interventions were mostly ineffective, leading to low nursing outcomes. IMPLICATIONS FOR NURSING PRACTICE: This study provides new insights on the nursing process and its documentation in Romania and a baseline for future research. Policymakers, administrators, and educators should consider educating nurses to use standardized nursing languages and apply the Advanced Nursing Process.

Knowledge translation for nursing care for patients with Risk of perioperative positioning injury: A case report.

PURPOSE: The aim was to apply the Advanced Nursing Process and demonstrating procedures of surgical positioning, as well as to show the participating the Nursing Outcomes Classification findings in order to translate the knowledge on specific preventive perioperative positioning into practice, the review of clinical protocols and nursing care plan. METHODS: The methods used include case report about knowledge translation by applying training modalities, review and adaptation of clinical protocols and examination of nursing care plans. FINDINGS: One hundred and nine healthcare providers attended the training, including nurses and nursing technicians working in the surgical center and the outpatient surgical center of the hospital chosen for this study. The surgical positioning protocols were revised based on the evidence described in the literature and the main surgical guidelines. The review of care registered in the institution's electronic system for the nursing prescription stage of the diagnosis Risk of perioperative positioning injury was based on the review on evidence on risk factors, the main guidelines in the area and the interventions suggested by Nursing Intervention Classification. The electronic system had registered 14 cares for this diagnosis, and after the review, one care was excluded and eight new cares were included, totaling 21 cares. CONCLUSION: Nursing teams play a prominent role in positioning patients for surgery, protecting them in a moment of extreme vulnerability, thus making knowledge about the fundamental elements of surgical positioning essential. This emphasizes the importance of training, and of reviewing protocols and records of procedures that promote safety to patients and care teams. IMPLICATION FOR NURSING PRACTICE: The translation of knowledge about the Advanced Nursing Process in the perioperative area contributes to the refinement of classifications and standardization of language in this scenario, subsidizing an evidence-based clinical practice.

OBJETIVO: O objetivo foi aplicar o Processo de Enfermagem Avançado e demonstrar procedimentos de posicionamento cirúrgico, bem como mostrar aos participantes os achados da Nursing Outcomes Classification para traduzir na prática o conhecimento específico sobre prevenção no posicionamento perioperatóriontivo, bem como a revisão de protocolos clínicos e do plano de cuidados de enfermagem. MÉTODOS: Relato de caso sobre tradução do conhecimento por meio da aplicação de modalidades de treinamento, revisão e adaptação de protocolos clínicos e análise de planos de cuidados de enfermagem. RESULTADOS: 109 profissionais de enfermagem participaram do treinamento, incluindo enfermeiros e técnicos de enfermagem que atuam no centro cirúrgico e no centro cirúrgico ambulatorial do hospital escolhido para este estudo. Os protocolos de posicionamento cirúrgico foram revisados com base nas evidências descritas na literatura e nas principais diretrizes cirúrgicas. A revisão dos cuidados registrados no sistema eletrônico da instituição para a etapa de prescrição de enfermagem do diagnóstico Risco de lesão por posicionamento perioperatório foi baseada na revisão das evidências sobre os fatores de risco, as principais diretrizes da área e as intervenções sugeridas pela Nursing Intervention Classification. O sistema eletrônico tinha 14 cuidados cadastrados para este diagnóstico, e após a revisão, um cuidado foi excluído e oito novos cuidados foram incluídos, totalizando 21 cuidados. CONCLUSÃO: A equipe de enfermagem tem papel de destaque no posicionamento do paciente para a cirurgia, protegendo-o em um momento de extrema vulnerabilidade, tornando imprescindível o conhecimento sobre os elementos fundamentais do posicionamento cirúrgico. Ressalta-se a importância do treinamento e da revisão de protocolos e registros de procedimentos que promovem a segurança do paciente e da equipe assistencial. IMPLICAÇÃO PARA A PRÁTICA DE ENFERMAGEM: A tradução do conhecimento sobre o Processo de Enfermagem Avançado na área perioperatória contribui para o refinamento das classificações e padronização da linguagem neste cenário, subsidiando uma prática clínica baseada em evidências.

Perception of Healthcare Workers on the Integration of Electronic Health Records in Primary Health Centers in Nigeria.

The study aim was to assess the perception of healthcare workers in primary healthcare centers toward the integration of EHRs into practice. A descriptive cross-sectional design was used. Out of 10 primary healthcare centers, 120 healthcare workers were selected by simple random sampling, whereas 109 questionnaires were fit for analysis. Data were collected using a questionnaire, and both descriptive and inferential statistics were used for data analyses. The findings revealed that the healthcare workers disagreed on EHR integration. They believed that user resistance, missing funds, and unavailability of knowledgeable support personnel are challenges that are hindering EHR integration. Also, limited training on how to use EHRs and lack of computer literacy were identified as challenges. Based on the literature and findings of this study, EHRs can improve the quality of the given patient care, reduce errors, increase productivity, and enable standardization of care. Therefore, education on EHR implementation and funding are needed to successfully integrate EHRs into primary healthcare centers in Nigeria.

Standardization of Quality of Diagnoses, Interventions, and Outcomes (Q-DIO) Measurement Instrument for Use in Slovenia.

PURPOSE: To describe the cross-cultural adaptation of the Quality of Diagnoses, Interventions and Outcomes (Q-DIO) Instrument into the Slovene language. METHODS: Based on general international guidelines, a six-step process of localization to translate and adjust the instrument from English into the Slovene language was used. Content validity was quantified based on an agreement of eight experts. The instrument was tested using a sample of 140 nursing documentations from two Slovenian tertiary hospitals. RESULTS: 26 of 29 items showed an excellent content validity index ranging from 0.857 to 1.000, and a modified kappa index above 0.856. The content validity indexes of the three remaining items adjusted based on experts' comments were subsequently estimated at 1.000. Construct validity was significantly different between the two groups of documentations. The Cronbach coefficient for the whole questionnaire was 0.860. Cronbach's alpha if item deleted reamins above 0.80 for all items. The criteria for the difficulty grades of items and discrimination validity were acceptably met for more than 75% of items. CONCLUSION: Based on the results of the study, it may be concluded that Q-DIO is a reliable instrument for measuring the quality of nursing documentation. The deviations in the results of some items are due to poor nursing documentation quality, and indicate that nursing classifications have not yet been fully implemented into practice in the study setting. Additional testing of the instrument is recommended.

[Risk of malnutrition in elderly patients in acute hospitals - implications for nursing practice]. / Gefahr einer Mangelernährung älterer Patient_innen im Akutspital.

Risk of malnutrition in elderly patients in acute hospitals - implications for nursing practice Abstract. Background: The risk of malnutrition is increased in advanced age and acute illness, and its assessment and needs-based support are part of the responsibility of nursing. Research question / objective: The following research question aims to analyse the nutritional status and possible correlations with nursing diagnoses and other patient characteristics from persons who are 80 years old and older: Which patterns in the sense of clusters can be identified concerning calorie and protein requirements and other patient characteristics? METHODS: Explorative cross-sectional study with cluster analysis based on food intake protocols and nursing documentation. Patients from surgery, internal medicine and university acute geriatric care wards were included in this non-probability sample. RESULTS: Four groups were formed out of the data from 135 patients (protein requirement coverage): Well-nourished (116 %), sufficiently-nourished (77 %), insufficiently-nourished (59 %) and poorly-nourished (40 %). A significant correlation between calorie and protein requirement coverage and treatment area has been shown. CONCLUSIONS: The degree of coverage of protein- and energy requirement is related to the treatment area and consequently to its team culture and treatment concept. Based on the characteristics of the well-nourished, a positive effect of interprofessional cooperation and systematic recording of the risk of malnutrition, as implemented in the treatment area of acute geriatric care, might be concluded.

Interventions to optimise nutrition in older people in hospitals and long-term care: Umbrella review.

BACKGROUND: Inpatients have a high need for protein-energy intake because of increased physical stress metabolism due to illnesses. Protein-energy undernutrition in older patients increases the risk of complications such as falls, pressure ulcers and even death. An overview of effective interventions addressing this complex issue of malnutrition in older people is missing. AIMS: To give an overview of effective interventions to optimise nutrition in older people in hospitals and long-term care. DESIGN: An umbrella review, according to the Joanna Briggs Institute and PRISMA statement, was conducted in April 2020. METHODS: A systematic search of publications from 2010 until 2020 was conducted in CINAHL, PubMed and Cochrane Database. Included were studies reporting nutrition interventions that involved nurses or the interprofessional team in optimising older hospitalised people's nutrition. Excluded were studies investigating the effects of parenteral nutrition, certain food supplements or tube feeding and research from intensive, community or palliative care. Components of interventions were classified according to the intervention Nutrition management: Patients' assistance, patients' instruction, foodservice, environment for meals and nutrient-dense snacks. FINDINGS: Included were 13 reviews from 19 countries of the continents Asia, Australia, Europe and North America from hospitals and long-term care settings. An interprofessional food promoting culture, including staff training as part of a multi-component measure, has shown to be a successful element in implementing activities of Nutrition Management. CONCLUSION: Several studies synthesised that optimising nutrition in older people in hospitals and long-term care is achievable. Interventions were effective if-on a meta-level-staff training was addressed as part of a multi-component measure to reach an interprofessional food promoting culture. IMPLICATIONS FOR PRACTICE: Interventions to optimise older people's nutrition have to consider an interprofessional food promoting culture, including staff training about the importance of nutrition, patients' assistance and an appropriate environment for meals.

Effekte von Guided Clinical Reasoning auf die Qualität des Advanced Nursing Process.

Effects of Guided Clinical Reasoning on the Advanced Nursing Process quality - An experimental intervention study Abstract. Background: The correctly applied Advanced Nursing Process leads demonstrably to more accurate nursing diagnoses and better nursing outcomes. It requires nurses' knowledge, clinical decision-making competency, and a positive attitude. Former Guided Clinical Reasoning (GCR) trainings significantly enhanced the Advanced Nursing Process quality. However, the congruence between nursing records, care situations, and patient interviews was not yet investigated. Research question: Which effects has GCR on nurses' knowledge, attitude, clinical performance, and on the quality of the Advanced Nursing Process? Methods: An experimental intervention study was carried out from 2016 until 2018 in a Swiss hospital. The 5-month intervention contained four seminar days and GCR-case meetings and was investigated by an evaluation model (n = 95 nurses, n = 24 patients, n = 225 nursing records). Results: After GCR training, nurses showed greater knowledge (p < 0,0001) and a more positive attitude (p = 0,004) on the Advanced Nursing Process than the control group. The congruence of nursing diagnoses, interventions, and outcomes between observations, interviews, and nursing records was higher in the intervention group. At the last measurement point, nursing diagnoses were stated significantly more accurate, interventions were more effective, and better patient outcomes were achieved (all p < 0,0005). Conclusions: GCR trainings should be used to enhance the Advanced Nursing Process quality, so that based on more accurate nursing diagnoses better patient outcomes are achieved.

Developing a nursing diagnosis for the risk for malnutrition: a mixed-method study.

AIM: As the risk for malnutrition in older people in hospitals is often underreported, we aimed to develop a risk nursing diagnosis, including label, definition and risk factors. DESIGN: A convergent parallel mixed-methods design was employed. METHODS: A literature review led to risk factors, validated by 22 hospitalized older people's perspectives and observations, including their nursing records. Per participant, one interview (qualitative), one non-participatory observation of three meals (198 hr; qualitative) and one nursing record evaluation (quantitative) were conducted. FINDINGS: According to the classification system of NANDA International, the risk for protein-energy malnutrition is defined with 18 risk factors, including associated conditions. Content validated risk factors are presented from three participants with the most, medium and least coherent nursing record, measured with the Quality of Diagnosis, Intervention and Outcomes tool. CONCLUSION: This new nursing diagnosis supports nurses to manage the risk for malnutrition and optimize older people's nutrition.

[The congruence of nursing diagnoses, interventions, and outcomes between care observations, patient perceptions, and nursing records: a qualitative multiple case study]. / Übereinstimmung des Advanced Nursing Process mit Beobachtungen, Interviews und Pflegedokumentationen im Akutspital.

The congruence of nursing diagnoses, interventions, and outcomes between care observations, patient perceptions, and nursing records: a qualitative multiple case study Abstract. Background: Nurses with good decision-making competencies state more relevant and accurate nursing diagnoses, perform more effective nursing interventions, and achieve better nursing-sensitive patient outcomes. It was reported that the content of nursing records sometimes doesn't match with statements of patients and nurses. RESEARCH QUESTION: In what extent do the recorded nursing diagnoses, interventions, and outcomes match with observed care situations and patients' statements? METHODS: A multiple case study with structured observations, guided interviews, and document analyses was performed. The congruence of nursing diagnoses, interventions, and outcomes between the three data sources was investigated by within- and cross-case-analysis in a sample of 24 patients. RESULTS: In total, 114 nursing diagnoses were identified of which 66 were recorded, 37 were found by observations, and 11 by patient interviews. A high congruence between the three perspectives was determined in 59 % of the recorded nursing diagnoses, in 41 % of nursing interventions, and in 33 % of nursing-sensitive patient outcomes. Almost all documented nursing diagnoses (89 %) were supported by most codes from all three sources. CONCLUSIONS: To increase the congruence of the three perspectives, nurses' clinical decision-making competencies should be fostered, so that nurses choose more effective nursing interventions that lead to better nursing-sensitive patient outcomes. Patient participation should be fostered.

Relationships between the Advanced Nursing Process quality and nurses' and patient' characteristics: A cross-sectional study.

Aim: This study aimed to assess (a) nurses' knowledge and their attitude towards the Advanced Nursing Process-nursing assessment, diagnoses, interventions, outcomes, (b) the quality of the Advanced Nursing Process and (c) relationships with patient characteristics. Design: A cross-sectional, descriptive correlational study was performed. Methods: Ninety-two registered nurses and ninety nursing records of six hospital wards were included. In January 2016, a knowledge test, a self-assessment tool for measuring nurses' attitude (PND) and the Quality of Diagnoses, Interventions and Outcomes Revised instrument (Q-DIO R) were applied. The correlations between nurses' knowledge, attitude, patient characteristics, organizational factors and the Advanced Nursing Process quality were investigated. Results: Nurses demonstrated low levels of knowledge, positive attitudes and an average Advanced Nursing Process quality. Accurate nursing diagnoses were strong and highly significantly related to effective nursing interventions and better nursing-sensitive patient outcomes. A higher proportion of registered nurses was related to better nursing outcomes.

Clinical indicators of nursing outcomes classification for patient with risk for perioperative positioning injury: A cohort study.

AIMS AND OBJECTIVES: To test the validity and reliability of Nursing Outcomes Classification outcomes and their clinical indicators for patients with the nursing diagnosis 'Risk for perioperative positioning injury'. BACKGROUND: Surgical positioning is an essential part of perioperative nursing practice. The use of a standardised language values the clinical evaluation of the perioperative nurse, reinforcing its contribution to surgical patient care. DESIGN: Longitudinal concept validation cohort study. METHODS: Patients were selected based on the operating room surgical schedule. The sample included adult patients who underwent elective surgical procedures requiring anaesthesia, classified as surgical class 2, 3 or 4. Outcomes were measured with an instrument, which included 33 clinical indicators for eight outcomes. The patients were assessed at five distinct time points in the perioperative phases. This study followed the STROBE guidelines. RESULTS: A total of 50 patients were included. Each underwent five clinical assessments, for a total of 250 documented assessments. Differences in evaluations were mostly related to reduced scores of clinical indicators in the immediate postsurgical time points, which recovered to the highest score at the end of the fifth (and last) evaluation. The results of factor analysis and Cronbach's alpha calculations suggested a new configuration for this nursing outcomes, consisting of five outcomes-Circulation Status, Tissue Perfusion: peripheral, Neurological Status: peripheral, Tissue Integrity: skin and mucous membranes and Thermoregulation-and 13 clinical indicators. CONCLUSIONS: Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnosis at 'Risk for perioperative positioning injury' are sensitive to patient states during the perioperative period. RELEVANCE TO CLINICAL PRACTICE: Use of nursing taxonomies during the perioperative period may contribute to the discussion on the role of perioperative nurses and their relevance in patient care.

Measuring the effects of guided clinical reasoning on the Advanced Nursing Process quality, on nurses' knowledge and attitude: Study protocol.

AIM: This article is a report of a study protocol designed to examine the effects of guided clinical reasoning on the quality of the Advanced Nursing Process-the evidence-based version of the traditional nursing process. It aims to describe the theoretical framework-Kirkpatrick's evaluation model, the key concepts and the instruments for the planned study. DESIGN: A complex experimental intervention study using data and method triangulation is proposed. METHODS: Registered Nurses (N = 92), nursing records (N = 180) and 24 patients will be included. Nurses' knowledge and attitude will be evaluated by questionnaires/tests, their clinical performance by observations. Patients' perspective will be addressed by qualitative interviews and patient records by using the instrument Quality of Diagnoses, Interventions and Outcomes revised (Q-DIO R). DISCUSSION: Kirkpatrick's model (including quantitative and qualitative methods) is providing evaluations from different perspectives on the quality of the Advanced Nursing Process and on intervention effects.

Competencies for nursing in a digital world. Methodology, results, and use of the DACH-recommendations for nursing informatics core competency areas in Austria, Germany, and Switzerland.

While Nursing Informatics competencies seem essential for the daily work of nurses, they are not formally integrated into nursing education in Austria, Germany and Switzerland, nor are there any national educational recommendations. The aim of this paper is to show how such recommendations can be developed, what competency areas are most relevant in the three countries and how the recommendations can be implemented in practice. To this end, a triple iterative procedure was proposed and applied starting with national health informatics recommendations for other professionals, matching and enriching these findings with topics from the international literature and finally validating them in an expert survey with 87 experts and in focus group sessions. Out of the 24 compiled competency areas, the relevance ratings of the following four recommended areas achieved values above 90%: nursing documentation (including terminologies), principles of nursing informatics, data protection and security, and quality assurance and quality management. As there were no significant differences between the three countries, these findings laid the foundation of the DACH Recommendations of Nursing Informatics as joint German (D), Austrian (A), and Swiss (CH) recommendations in Nursing Informatics. The methodology proposed has been utilized internationally, which demonstrates the added value of this study also outside the confines of Austria, Germany, Switzerland.

Documented Nursing Interventions in Inpatient Psychiatry.

PURPOSE: This study explored how well the Nursing Interventions Classification (NIC) covers adult inpatient psychiatric care. METHODS: By systematic analyses and a mapping approach, documented nursing interventions were assessed on concurrencies with the NIC. FINDINGS: From 2,153 intervention descriptions in nursing notes, 1,924 were recognizable as NIC interventions, and 229 did not match the NIC. 89.4% of all identified descriptions of interventions were recognizable as NIC interventions on the level of definition. CONCLUSIONS: This study demonstrates that the NIC describes adult inpatient psychiatric care to a large extent. Nevertheless, further development of the classification is important. PRACTICE IMPLICATIONS: The study results provide a basis for further developing the NIC and to reinforce its use in inpatient psychiatric settings.

Nursing diagnoses related to psychiatric adult inpatient care.

AIMS AND OBJECTIVES: To detect the prevalence of NANDA-I diagnoses and possible relationships between those and patient characteristics such as gender, age, medical diagnoses and psychiatric specialty/setting. BACKGROUND: There is a lack on studies about psychiatric inpatient characteristics and possible relationships among these characteristics with nursing diagnoses. DESIGN: A quantitative-descriptive, cross-sectional, completed data sampling study was performed. METHODS: The data were collected from the electronic patient record system. Frequencies for the social-demographic data, the prevalence of the NANDA-I diagnoses and the explanatory variables were calculated. RESULTS: In total, 410 nursing phenomena were found representing 85 different NANDA-I diagnoses in 312 patients. The NANDA-I diagnosis "Ineffective Coping" was the most frequently stated diagnosis followed by "Ineffective Health Maintenance," "Hopelessness" and "Risk for Other-Directed Violence". Men were more frequently affected by the diagnoses "Ineffective Coping," "Hopelessness," "Risk for Self-Directed Violence," "Defensive Coping" and "Risk for Suicide," whereas the diagnoses "Insomnia," "Chronic Confusion," "Chronic Low Self-Esteem" and "Anxiety" were more common in women. Patients under the age of 45 years were more frequently affected by "Chronic Low Self-Esteem" and "Anxiety" than older patients. "Ineffective Coping" was the most prevalent diagnosis by patients with mental disorders due to psychoactive substance use. Patients with schizophrenia were primarily affected by the diagnoses "Ineffective Coping," "Impaired Social Interaction" and "Chronic Low Self-Esteem." CONCLUSIONS: This study demonstrates the complexity and diversity of nursing care in inpatient psychiatric settings. Patients' gender, age and psychiatric diagnoses and settings are a key factor for specific nursing diagnosis. RELEVANCE TO CLINICAL PRACTICE: There are tendencies for relationships between certain nursing diagnosis and patient characteristics in psychiatric adult inpatients. This enhances the specific, extended knowledge for nursing care and its demands in this setting and therefore supports the daily nursing psychiatric care and its needs.

Determination of Nursing Diagnoses in Children of Agricultural Laborer Families in South Eastern Regions of Turkey.

PURPOSE: Identifying functional health patterns and nursing diagnoses of migrant agricultural laborer families. METHODS: Interpretative-qualitative study based on interviews with 162 mothers of 0- to 2-year-old children in two Turkish provinces. FINDINGS: Health perception-health management: growth and development, risk for being delayed; health maintenance, ineffective; health behavior, risk-prone; risk for contamination; risk for sudden infant death syndrome; and risk for injury. Nutritional-metabolic: Risk for infection; and breastfeeding, interrupted. Self-perception: risk for chronic low self-esteem, disturbed self-esteem; and powerlessness. Role-relationship: impaired parenting; and dysfunctional family process. Coping-stress tolerance: coping, disabled family; violence, risk for other-directed. Cognitive-perceptive: knowledge deficit CONCLUSIONS: Nursing diagnoses of this population were reported for the first time. IMPLICATIONS: Addressing agricultural laborer families' diagnoses will positively affect maternal-child health.

Interventions of the nursing diagnosis "Acute Pain" ­ Evaluation of patients' experiences after total hip arthroplasty compared with the nursing record by using Q-DIO-Pain: a mixed methods study / Interventionen zur Pflegediagnose "Akute Schmerzen" ­ Evaluation der schmerzlindernden Pflege bei hospitalisierten Patientinnen und Patienten nach Hüftendoprothesenversorgung im Vergleich zur Pflegedokumentation mittels Q-DIO-Pain: eine Mixed Methods Studie.

Background: Pain affects patients' rehabilitation after hip replacement surgery. Aim: The study aim was to compare patients' responses, on their received pain relieving nursing interventions after hip replacement surgery, with the documented interventions in their nursing records. Method: A mixed methods design was applied. In order to evaluate quantitative data the instrument "Quality of Diagnoses, Interventions and Outcomes" (Q-DIO) was further developed to measure pain interventions in nursing records (Q-DIO-Pain). Patients (n = 37) answered a survey on the third postoperative day. The patients' survey findings were then compared with the Q-DIO-Pain results and cross-validated by qualitative interviews. Results: The most reported pain level was "no pain" (NRS 0 ­ 10 Points). However, 17 ­ 50 % of patients reported pain levels of three or higher and 11 ­ 22 % of five or higher in situations of motion / ambulation. A significant match between patients' findings and Q-DIO-Pain results was found for the intervention "helping to adapt medications" (n = 32, ICC = 0.111, p = 0.042, CI 95 % 2-sided). Otherwise no significant matches were found. Interviews with patients and nurses confirmed that far more pain-relieving interventions affecting "Acute Pain" were carried out, than were documented. Conclusions: Based on the results, pain assessments and effective pain-relieving interventions, especially before or after motion / ambulation should be improved and documented. It is recommended to implement a nursing standard for pain control.

Sensory overload: A concept analysis.

In the context of mental disorders sensory overload is a widely described phenomenon used in conjunction with psychiatric interventions such as removal from stimuli. However, the theoretical foundation of sensory overload as addressed in the literature can be described as insufficient and fragmentary. To date, the concept of sensory overload has not yet been sufficiently specified or analyzed. The aim of the study was to analyze the concept of sensory overload in mental health care. A literature search was undertaken using specific electronic databases, specific journals and websites, hand searches, specific library catalogues, and electronic publishing databases. Walker and Avant's method of concept analysis was used to analyze the sources included in the analysis. All aspects of the method of Walker and Avant were covered in this concept analysis. The conceptual understanding has become more focused, the defining attributes, influencing factors and consequences are described and empirical referents identified. The concept analysis is a first step in the development of a middle-range descriptive theory of sensory overload based on social scientific and stress-theoretical approaches. This specification may serve as a fundament for further research, for the development of a nursing diagnosis or for guidelines.