Nursing Care Plan for Patients with Tay-Sachs-A Rare Paediatric Disease.

Tay-Sachs disease is classified as a rare paediatric disease of metabolic origin. It is an autosomal recessive inherited disease. The gene responsible for the disease is known as HEXA, and it is located on chromosome 15(15q23). There is currently no effective treatment for Tay-Sachs disease; hence, it is an incurable disease in which patients do not live for more than five years, meaning that nursing care takes on greater importance to maintain quality of life. The main objective of this work is to develop a specific standard nursing care plan by applying an inductive research method supported by nursing methodology using the NANDA-NIC-NOC taxonomy and validated by the Delphi method. This care plan will improve the knowledge of health professionals on this topic and support future studies on the disease. Following its implementation, the care plan proposed in this study aims to increase the quality of life of patients diagnosed with this disease.

Síndrome de DRESS asociado a alopurinol con fracaso renal agudo: a propósito de un caso / DRESS syndrome associated with alopurinol with acute kidney injury: a case report

Introducción: El síndrome de DRESS es una reacción mucocutánea y visceral grave provocada por fármacos que puede llegar a provocar la muerte por la afectación de hígado y riñón.Caso Clínico: Varón de 46 años que presentó un exantema generalizado no pruriginoso, junto con fiebre, síntomas digestivos, adenopatías cervicales y sudoración nocturna coincidiendo con la toma previa de alopurinol. Tras el ingreso en el hospital se le diagnostica hepatitis aguda y deterioro de la función renal con oliguria, necesitando realización de hemodiálisis urgente. Tras un tratamiento multidisciplinar entre los servicios de nefrología, digestivo y hematología, el paciente es dado de alta con mejora de su función renal, pero continúa en seguimiento ambulatorio.Conclusiones: El alopurinol, fármaco muy utilizado en la práctica clínica, puede tener reacciones adversas muy graves, poniendo en riesgo la vida del paciente.El síndrome de DRESS, al ser muy poco frecuente, no tiene un tratamiento estandarizado. En el caso concreto de nuestro paciente, una detección temprana, junto a un tratamiento efectivo, con recambios plasmáticos con albúmina, hemodiálisis y corticoides, propiciaron una evolución favorable del paciente, con recuperación de la función renal. (AU)

Introduction: DRESS syndrome is a severe drug-induced mucocutaneous and visceral reaction that can be fatal due to liver and kidney damage. Case report: A 46-year-old man developed a generalised, non-pruritic rash, together with fever, digestive symptoms, cervical lymphadenopathy and night sweats coinciding with the previous intake of allopurinol. On hospital admission, he was diagnosed with acute hepatitis and deterioration of renal function including oliguria, requiring urgent hemodialysis. After a multidisciplinary treatment by the nephrology, digestive and haematology departments, the patient was discharged with an improvement in renal function, although he continued to be monitored on an ambulatory service. Conclusions: Allopurinol, a widely used drug in clinical prac-tice, can cause severe and life-threatening adverse reactions.DRESS syndrome, being very rare, has no standardised treat-ment. Specifically in the case of the patient, early detection, combined with effective treatment, including plasma replace-ment with albumin, hemodialysis and corticosteroids, favou-rably influenced the patient’s evolution, with recovery of renal function. (AU)

Barriers to the application of the nursing methodology in the Intensive Care Unit.

INTRODUCTION: The Nursing Process is the scientific method specific to the nursing discipline. However, although in recent years it has rapidly expanded in certain areas, this has not been the case in special units such as the intensive care unit. OBJECTIVE: To determine the reasons nurses show little awareness of incorporating nursing methodology in intensive care units. METHOD: Literature review conducted between November and December 2020 in the databases Pubmed, Cinahl, Cuiden, Lilacs, Cochrane, Sicelo, Web of Science, in addition to a search of grey literature and electronic journals. Boolean operators AND and OR were used and the temporal limiter of the last 10 years (2010-2020) was applied. RESULTS: A total of 20 articles were selected. Intensive Care Units nurses perceived a lack of knowledge on how to use nursing methodology. This problem begins in university education and continues in the institutions with little continuing education. Nurses' work overload takes time from being able to use this tool, which is among the lowest of their priorities. CONCLUSIONS: Research studies are required on solutions that, in the nurses' words, could be useful in tackling this problem, and on the impact that training programmes in methodology have on its application in practice.

Barreras para la aplicación de la metodología enfermera en la unidad de cuidados intensivos / Barriers to the application of the nursing methodology in the Intensive Care Unit

Introducción: El proceso enfermero constituye el método científico propio de la disciplina enfermera. Y, aunque en los últimos años ha experimentado una rápida expansión en determinados espacios, no ha ocurrido así en unidades especiales como la unidad de cuidados intensivos. Objetivo: Determinar los motivos por los que las enfermeras muestran poca sensibilización hacia la incorporación de la metodología enfermera en las unidades de cuidados intensivos. Método: Revisión bibliográfica realizada entre noviembre y diciembre de 2020 en las bases de datos Pubmed, Cinahl, Cuiden, Lilacs, Cochrane, Sicelo, Web of Science, además de una búsqueda en literatura gris y en revistas electrónicas. Se emplearon los operadores booleanos AND y OR y se aplicó el limitador temporal de los últimos 10 años (2010-2020). Resultados: Se seleccionaron un total de 20 artículos. Las enfermeras de la unidad de cuidados intensivos percibieron una falta de conocimientos sobre el uso de la metodología enfermera cuyo problema comienza desde la formación universitaria y se prolonga dentro de las instituciones con la escasa formación continuada. Mientras que la sobrecarga de trabajo restó tiempo para poder emplear esta herramienta que se encuentra entre las últimas prioridades de las enfermeras. Conclusiones: Se hace necesario realizar estudios de investigación sobre las soluciones que, en palabras de los/as enfermeros/as podrían ser útiles para abordar este problema, así como el impacto que los programas de formación en metodología tienen sobre su aplicación en la práctica.(AU)

Introduction: The nursing process is the scientific method specific to the nursing discipline. However, although in recent years it has rapidly expanded in certain areas, this has not been the case in special units such as the intensive care unit. Objective: To determine the reasons nurses show little awareness of incorporating nursing methodology in Intensive Care Units. Method: Literature review conducted between November and December 2020 in the databases Pubmed, Cinahl, Cuiden, Lilacs, Cochrane, Sicelo, Web of Science, in addition to a search of grey literature and electronic journals. Boolean operators AND and OR were used and the temporal limiter of the last 10 years (2010-2020) was applied. Results: A total of 20 articles were selected. Intensive Care Units nurses perceived a lack of knowledge on how to use nursing methodology. This problem begins in university education and continues in the institutions with little continuing education. Nurses’ work overload takes time from being able to use this tool, which is among the lowest of their priorities. Conclusions: Research studies are required on solutions that, in the nurses’ words, could be useful in tackling this problem, and on the impact that training programmes in methodology have on its application in practice.(AU)

Nursing Care Plan for Patients with Hajdu-Cheney Syndrome.

Hajdu-Cheney syndrome is a rare genetic disease. Its main features include phenotypic variability, age-dependent progression and the presence of acroosteolysis of the distal phalanges and generalized osteoporosis, which have significant disabling potential. Currently, there is no effective curative treatment, so nursing care is essential to ensure the maintenance of the quality of life of these patients. The main objective of this study was to establish a specific standardized nursing care plan using the NANDA-NIC-NOC taxonomy. The application of a care plan as such would improve the quality of life of patients affected by this rare disease, will contribute to increasing healthcare professionals' knowledge on this matter and will support future studies on this disease.

Application and Evaluation of a Care Plan for Enhanced Recovery After Thyroidectomy.

Purpose: To develop and evaluate a nursing care plan based on the ERAS (Enhanced Recovery After Surgery) approach for thyroid surgery patients. Methods: A nursing care plan has been developed after the literature review and focus group discussion. The content was validated using the Delphi method. Then, a quasi-experimental study was designed. A total of 120 cases with thyroid surgery at Ruijin Hospital from March to June 2018 were divided equally into an ERAS group and a conventional group Results: The nursing care plan consisted of 13 first-level and 32 second-level indicators. (P < .001). Strikingly the outcomes, such as pain scores, length of hospital stay, and hospitalization costs, were significantly less in the ERAS group than those in the conventional group (P<.001), while no difference was detected in the postoperative complications rate. Conclusion: A scientific and reliable nursing care plan has been used for thyroidectomy patients to enhance recovery.

Epidermolysis Bullosa: A case study in Cyprus and the nursing care plan.

PURPOSE: To present a case study with Epidermolysis bullosa (EB) in Cyprus and to determine the nursing care plan, explaining the nursing interventions and showing the importance of nursing care of patients with EB. METHODS: Literature review on EB and semi-structured interviews commenced through a direct discussion with open-ended questions to the research subject as well as to a close relative describing his feelings, experiences, and concerns about the disease. FINDINGS: Thematic analysis approach was used to identify and analyze patterns in the data. Then, data were synthesized using the standardized nursing terminology of NANDA-I and the Nursing Interventions Classification. The accuracy of the diagnoses and the appropriateness of the nursing interventions were supported by the positive health outcomes of the patient. CONCLUSIONS: Nurses should apply evidence-based practice interventions for EB wound care, pain management, nutrition, psychological and social support to these patients. IMPLICATIONS FOR NURSING PRACTICE: Although EB is classified in the category of rare diseases, the presentation of a case study in Cyprus and the nursing care plan contribute further bibliographically to the holistic and at the same time individualized nursing practice.

Challenges using electronic nursing routine data for outcome analyses: A mixed methods study.

OBJECTIVES: To explore the challenges of secondary use of routinely collected data for analyzing nursing-sensitive outcomes in Austrian acute care hospitals. METHOD: A convergent parallel mixed methods design was performed. We conducted a quantitative representative survey with nursing managers from 32 Austrian general acute care hospitals and 11 qualitative semi-structured interviews with nursing quality management experts. Both results were first analyzed independently and afterward merged in the discussion. RESULTS: On average, 76% of nursing documentation is already electronically supported in the surveyed Austrian hospitals. However, existing nursing data is seldom used for secondary purposes such as nursing-sensitive outcome analyses. This is due to four major reasons: First, hospitals often do not have a data strategy for the secondary use of routine data. Second, hospitals partly lack the use of standardized and uniform nursing terminologies, especially for nursing evaluation. Third, routine nursing data is often not documented correctly and completely. Fourth, data on nursing-sensitive outcomes is usually collected in specific documentation forms not integrated into routine documentation. CONCLUSION: The awareness of the possibilities for secondary use of nursing data for nursing-sensitive outcome analyses in Austrian hospitals is still in its infancy. Therefore, nursing staff and nursing management must be trained to understand how to collect and process nursing data for nursing-sensitive outcome analyses. Further studies would be interesting in order to determine the factors that influence the decision-making processes for the secondary use of nursing data for outcome analyses.

Electronic nursing care plans through the use of NANDA, NOC, and NIC taxonomies in community setting: A descriptive study in northern Italy.

PURPOSE: To carry on a descriptive analysis of nursing standardized language through the use of a software within outpatient facilities in northern Italy, organized according to the Chronic Care Model (CCM) and called Community Health Centers (CHC). METHODS: A descriptive design was adopted for the study. NANDA-I, NOC, and NIC taxonomies have been used to analyze care plans pulled from the software. Both qualitative and quantitative data were analyzed. FINDINGS: The average of nursing diagnosis correctly identified with respect to the nursing assessment is 83.7% (SD 29.9%). Class 4 diagnoses from Domains 4 have been identified as the most prevalent (22.4%), followed by risk for unstable blood glucose level 00179 (16.4%) and risk for overweight 00234 (13%). The main nursing outcomes were vital signs 0802 (22.5%), blood glucose level 2300 (16%), and weight loss behavior 1627 (11%). The most prevalent nursing interventions are wound care 3660 (27%), medication administration: intramuscular 2313 (19%), and health education 5510 (14%). The analysis shows ability in identifying nursing diagnoses, but a larger variability with outcomes and interventions. The study highlights the nursing role within CHC and identifies the main areas of expertise in chronic disease management: prevention and health education. CONCLUSIONS: Nurses' role is fundamental for chronic disease management within CHC; NANDA-I taxonomy helps to analyze care plans. IMPLICATIONS FOR NURSING PRACTICE: - A taxonomy such as NANDA-I represents a valid opportunity to make more visible how much nursing skills affect the achievement of a higher level of health in chronic patients. - This study is useful in the further training of outpatient nurses who works in CHC. - The study represents the starting point for future research to deepen the development of a standardized nursing language in outpatient facilities.

SCOPO: Effettuare un'analisi descrittiva del linguaggio infermieristico standardizzato attraverso l'utilizzo di un software all'interno di strutture ambulatoriali del nord Italia, organizzate secondo il Chronic Care Model (CCM) e denominate Case della Salute (CdS). METODI: Per lo studio è stato adottato un disegno descrittivo. Le tassonomie NANDA-I, NOC e NIC sono state utilizzate per analizzare i piani di assistenza estratti dal software. Sono stati analizzati dati sia qualitativi che quantitativi. RISULTATI: La media delle diagnosi infermieristiche correttamente identificate rispetto all'accertamento infermieristico è dell'83,7% (DS 29,9%). Le diagnosi di classe 4 dominio 4 sono state identificate come le più prevalenti (22,4%), seguite da 00179 (16,4%) e 00234 (13%). I principali esiti infermieristici sono stati 0802 (22,5%), 2300 (16%) e 1627 (11%). Gli interventi infermieristici più diffusi sono 3660 (27%), 2313 (19%) e 5510 (14%). L'analisi di adeguatezza mostra la capacità di identificare le diagnosi infermieristiche, ma una maggiore variabilità con i risultati e gli interventi. Lo studio evidenzia il ruolo infermieristico all'interno delle CdS e identifica le principali aree di competenza nella gestione delle malattie croniche: prevenzione ed educazione sanitaria. CONCLUSIONI: Il ruolo degli infermieri è fondamentale per la gestione delle malattie croniche all'interno delle CdS; La tassonomia NANDA-I aiuta ad analizzare i piani di cura. IMPLICAZIONI PER LA PRATICA INFERMIERISTICA: - L'utilizzo di una tassonomia condivisa e standardizzata come NANDA-I nella creazione dei piani di assistenza rappresenta una valida opportunità per rendere più visibile quanto le competenze infermieristiche influenzino il raggiungimento di un livello più alto di salute e benessere nei pazienti cronici trattati nelle CdS. - Questo studio è utile per la formazione degli infermieri ambulatoriali e per quelli che lavoreranno lì. - Lo studio rappresenta il punto di partenza per future ricerche per approfondire ulteriormente, magari a livello multicentrico, lo sviluppo di un linguaggio infermieristico standardizzato attraverso la creazione di piani di assistenza infermieristica basati sulla tassonomia NANDA-I.

The Effects of Case Study-based Learning on Nursing Care Plan Ability in Nursing Process of Nursing Students

@#Introduction: Nursing care planning based on case studies develops students’ nursing ability and competence of knowing, understanding, applying, analyzing, and evaluating knowledge. The objectives this Quasi-Experimental research aimed to compare nursing students’ ability to create nursing care plans after receiving the development program focused on clinical nursing care planning through case study-based learning. Methods: The subjects included 70 third year nursing students, academic year 2019, Boromarajonani College of Nursing Nakhon Phanom, Nakhonphanom University. The data collection was conducted from January – December 2020 using a case study -based development program, data collection record form, knowledge test on critical nursing care and ability test in making nursing care plans. Finally, data were analyzed using wilcoxon matched pairs signed-ranks test. Results: The results revealed that the students had a higher level of knowledge of critical nursing care after program participation (p < .05) and the ability to create nursing plans also increased after the program participation (p=05). Conclusion: The findings indicate that this teaching and learning approach was found appropriate to be used in nursing clinical practicum.

The Potential of AI in Care Optimization: Insights from the User-Driven Co-Development of a Care Integration System.

Transitions from one level of care to another are complex processes that pose medical and organizational risks and depend on care integration between different providers. This qualitative study investigated user experiences with an existing digital system for care integration between hospitals and nursing homes, and the potential of artificial intelligence to contribute to its optimization. The findings reveal challenges regarding (a) untimely information, (b) irrelevant information, (c) confusing information, (d) missing information, (e) information overload, and (f) information multiplicity. Artificial intelligence could address these by (i) identifying and verifying low-quality information, (ii) targeting information for different user groups, (iii) visually summarizing relevant information, and (iv) jointly presenting multiple versions. The implications of these findings extend beyond the context of care integration, presenting empirical evidence for the importance of qualitative health research in, and a model for, determining the scope and design of future artificial intelligence solutions to optimize (health)care processes.

Infección y explante de DAI por decúbito, a propósito de un caso / Infection and explant of ICD due to decubitus, regarding a case

Se presenta el caso de un paciente varón de 73 años que, tras haberse implantado un desfibrilador automático interno (DAI), fue ingresado en el hospital por presentar decúbito del DAI con exposición de electrodos y presencia de exudado. Tras evidenciarse infección con diferentes pruebas analíticas y de imagen, se procedió a retirar el desfibrilador.Se realizó una valoración enfermera holística previa a la cirugía de explante del DAI por Patrones Funcionales de la Salud de Marjory Gordon y se llevó a cabo un plan de cuidados empleando la taxonomía diagnóstica de la North American Nursing Diagnosis Association (NANDA), describiendo los resultados esperados según la Nursing Outcomes Classification (NOC) y enunciado las intervenciones necesarias según la Nursing Intervention Classification (NIC). Se identificaron dos diagnósticos enfermeros: [00214] Disconfort y [00161] Disposición para mejorar los conocimientos; y dos problemas de colaboración: [00046] Deterioro de la integridad cutánea y [00146] Ansiedad. A continuación se escogió una serie de Resultados NOC: Bienestar personal, Integridad tisular de piel y membranas mucosas, Conocimiento del control de la infección y Autocontrol de la ansiedad; con sus respectivos indicadores a los que se les asignó una puntuación inicial y una puntuación diana o esperada. Por último, se identificaron intervenciones enfermeras a llevar a cabo con sus correspondientes actividades.Al cabo de un mes, previamente al alta hospitalaria, se evaluaron de nuevo los indicadores obteniéndose una puntuación final igual a la puntuación diana y, en algún indicador, una puntuación final mayor a la esperada destacando el NOC Conocimiento del control de la infección.(AU)

Presenting the case of a male 73-year-old patient who, after Internal Cardiac Defibrillator (ICD) implantation, was admitted to hospital due to ICD decubitus with electrode exposure and presence of exudate. After infection was confirmed through different lab and imaging tests, the defibrillator was removed.Holistic nursing assessment was conducted before the ICD explant surgery, through Marjory Gordon’s Functional Health Patterns, and a plan of care was conducted using the North American Nursing Diagnosis Association (NANDA) diagnostic terminology, describing the expected outcomes according to the Nursing Outcomes Classification (NOC) and stating the necessary interventions according to the Nursing Intervention Classification (NIC). Two nursing diagnoses were identified: [00214] Discomfort and [00161] Readiness for Enhanced Knowledge; and two collaboration problems: [00046] Impairment of skin integrity, and [00146] Anxiety. A series of NOC outcomes was then selected: Personal wellbeing, Skin tissue and mucous membrane integrity, Knowledge of infection control, and Anxiety self-control, with their appropriate indicators these were assigned with an initial score and a target or expected score. Finally, nursing interventions to be carried out were identified with their corresponding activities.After one month, and before hospital discharge, the indicators were assessed again, and the final score obtained was equal to the target score; and in some indicator, there was a final score higher to the expected one, highlighting the NOC Knowledge of infection control.(AU)

Sistematização da assistência de enfermagem a pacientes adultos com diagnóstico de sepse / Systematization of nursing care for adult sepsis patients / Sistematización de la asistencia de enfermería a pacientes adultos con diagnóstico de sepsis

A sepse consiste em uma síndrome clínica associada à presença de infecção com repercussões e disfunções sistêmicas, sendo considerada um problema de saúde pública mundial. Esta pesquisa teve como objetivo analisar evidências na literatura científica acerca de assistência de enfermagem desenvolvida para indivíduos adultos com sepse. Para isso, foi realizada uma revisão integrativa da literatura sobre o tema. Pesquisou-se nos bancos de dados Lilacs, PubMed e Cinahl, a partir dos descritores: sepsis; nursing; care nursing; patient care planning. O tempo das publicações limitou-se ao período de 2007 a 2017. A amostra consistiu em 24 artigos primários, que foram agrupados em três categorias temáticas conforme as ideias centrais: implantação de protocolos e instrumentos padronizados para identificação da sepse; aplicação de cuidados de enfermagem na sepse; processos educacionais e pesquisas para qualificação da enfermagem. Os principais cuidados envolveram a identificação de sinais clínicos de sepse, administração de antimicrobianos, fluidos e vasopressores, monitoramento eletrônico, coleta de lactato e gasometrias, curva glicêmica, sistematização da assistência de enfermagem e processos educacionais no trabalho. Identificaram-se a aplicação de ferramentas de triagem e o desenvolvimento de instrumentos para identificação de disfunções orgânicas e de pesquisas para qualificação da assistência a pacientes sépticos. O estudo concluiu que pacientes adultos com sepse exigem cuidados específicos de enfermagem, baseados em metodologias assistenciais fundamentadas em evidências científicas, como protocolos e ferramentas, assim como revelou a necessidade de métodos educacionais para melhoria da atuação da enfermagem.

Sepsis is a clinical syndrome associated with infection with systemic repercussions and dysfunctions, being considered a global public health issue. This study sought to analyze the scientific literature on nursing care for adults diagnosed with sepsis. For this purpose, an integrative literature review was carried out by searching the LILACS, PubMed and CINAHL databases, using the following descriptors: sepsis; nursing; nursing care; patient care planning. Publication time was limited from 2007 to 2017. The 24 primary articles selected were grouped into three thematic categories according to central ideas, namely: Implementation of protocols and standardized instruments for sepsis identification; Application of nursing care in sepsis; Educational processes and research for nursing qualification. The main care involved identification of clinical signs of sepsis, administration of antimicrobial, fluids and vasopressors, electronic monitoring, lactate and blood gas collection, glycemic curve, systematization of nursing care, and educational processes at work. Application of screening tools, development of instruments to identify organ dysfunctions and research to qualify the care for septic patient were identified. The research concluded that adult septic patients require specific nursing care based on evidence-based assistive methodologies, such as protocols and tools, and revealed the need for educational methods to improve nursing performance.

La sepsis es un síndrome clínico asociado a la presencia de infección con repercusiones y disfunciones sistémicas, considerada un problema de salud pública mundial. Esta investigación tuvo por objetivo analizar evidencia en la literatura científica acerca de asistencia de enfermería desarrollada para individuos adultos con sepsis. Para ello, se realizó una revisión integrativa de la literatura sobre el tema. Se hizo una búsqueda en las bases de datos Lilacs, PubMed y Cinahl a partir de los descriptores: sepsis; nursing; care nursing; patient care planning. El tiempo de las publicaciones se limitó de 2007 a 2017. La muestra consistió en 24 artículos primarios, que fueron agrupados en tres categorías temáticas conforme a las ideas centrales: Implantación de protocolos e instrumentos estandarizados para la identificación de sepsis; Aplicación de cuidados de enfermería en la sepsis; y Procesos educativos e investigaciones para la calificación de la enfermería. Los principales cuidados involucraron la identificación de signos clínicos de sepsis, administración de los antimicrobianos, fluidos y vasopresores, monitoreo electrónico, recolección de lactato y gasometrías, curva glucémica, sistematización de la asistencia de enfermería y procesos educativos en el trabajo. Se identificó la aplicación de herramientas de clasificación, desarrollo de instrumentos para la identificación de disfunciones orgánicas y de investigaciones para la calificación de la asistencia a pacientes sépticos. Se concluyó que los pacientes adultos con sepsis exigen cuidados específicos de la enfermería basados en metodologías asistenciales fundamentadas en evidencia científica, como protocolos y herramientas, así como la necesidad de métodos educativos para mejorar la actuación de la enfermería.

Non-application of the nursing process at a hospital in Accra, Ghana: lessons from descriptive research.

BACKGROUND: Registered nurses in Ghana are trained to plan the care that they provide to their patients in a systematic and organized manner. This scientific approach to care is known as the nursing process. There is evidence that the nursing process is not being practised by professional nurses in Ghana, as expected. This research seeks to explore what informs nursing interventions in the clinical area. METHODS: A qualitative study was conducted with ten registered nurses; and this was descriptive in nature. One-on-one interviews were conducted with the research participants, as a means of collecting the data. A semi-structured interview guide was used as the data-collecting tool. The collected data were analysed by using latent-content analysis. Three main themes emerged from the data analysis. RESULTS: It was found that registered nurses did not plan their nursing care. The care that the nurses provided was based on routine nursing care and doctors' orders, both verbal and non-verbal; or written communication were the means whereby the care was provided; and that was communicated among the nurses. CONCLUSION: Registered nurses are taught the nursing process; and they are expected to implement the acquired knowledge in the clinical area. The failure of nurses to practise the expected standard of care results in their relying on the decision of other health-care professionals, such as doctors. This makes registered nurses appear to be assistants to doctors. We, therefore, conclude that nurse leaders must supervise nurses to put into practice what they were taught during their training; so that they can have professional autonomy in their practice as nurses. It is also suggested that nurses must show evidence of using the nursing process in their daily work by the use of the nursing care-plan form.

Don't Ignore My Snore: Reducing Perioperative Complications of Obstructive Sleep Apnea.

PURPOSE: Obstructive sleep apnea (OSA), a condition associated with decreased muscle tone in the airway, has been linked to postoperative complications. The purpose of the initiative was to develop and implement a guideline for patients identified as high-risk for OSA to reduce complications related to OSA. DESIGN: A multidisciplinary team developed the guideline utilizing the Iowa Model of Evidence-Based Practice to Promote Quality Care. METHODS: PubMed literature search from 2006-2013 and critique of over 40 articles were completed. A nursing care plan was created from the guideline to facilitate communication of care for this population. FINDINGS: Postoperative cardiopulmonary complications related to OSA decreased from 27% to 14.6% after guideline implementation. CONCLUSIONS: Guideline and nursing care plan specific to OSA in the perioperative setting improved patient outcomes.

Factors that influence the clinical utilization of the nursing process at a hospital in Accra, Ghana.

BACKGROUND: The nursing process is a tool that is recommended for use by all professional nurses working in Ghana, in order to provide nursing care. However, there is currently a limited use of this tool by nurses in Ghana. The purpose of this research study was to explore the various factors that influence the utilization of this nursing process. METHOD: An exploratory descriptive qualitative-research design was employed. Ten participants were involved by using the purposive sampling method. A semi-structured interview guide was used to collect the data from the research participants; and the data were analysed by using content analysis. One main theme, with five subthemes, emerged from the analysis. RESULTS: It was found that there are factors, such as nurses not having a better understanding of the nursing process, whilst in school; the absence of the care plan in the ward, as well as the lack of adequate staff, with limited time being available for coping with contributed to the non-usage of the nursing process. CONCLUSIONS: We conclude that the clinical utilization of the Nursing process at the clinical setting is influenced by lack of understanding of Nurses on the Nursing process and care plan as well as lack of adequate nurses and time. We recommend that the care-plan form be made officially a part of the admission documents. Furthermore, the nursing administration should put measures in place to provide nurses with the needed resources to implement the nursing process. Additionally, they should ensure that the care-plan forms and other resources needed by the nurses are regularly and adequately provided. Nurses should further see the nursing process as a means of providing comprehensive care to their patients and addressing their specific problems. They should therefore make time despite their busy schedules to use it in order to improve quality of care and the image of nursing in Ghana.

Effectiveness of concept mapping and traditional linear nursing care plans on critical thinking skills in clinical pediatric nursing course.

INTRODUCTION: Concept map is a useful cognitive tool for enhancing a student's critical thinking (CT) by encouraging students to process information deeply for understanding. However, the evidence regarding its effectiveness on nursing students' CT is contradictory. This paper compares the effectiveness of concept mapping and traditional linear nursing care planning on students' CT. METHODS: An experimental design was used to examine the CT of 60 baccalaureate students who participated in pediatric clinical nursing course in the Shahrekord University of Medical Sciences, Shahrekord, Iran in 2013. RESULTS: Participants were randomly divided into six equal groups of each 10 student, of which three groups were the control group, and the others were the experimental group. The control group completed nine traditional linear nursing care plans, whereas experimental group completed nine concept maps during the course. Both groups showed significant improvement in overall and all subscales of the California CT skill test from pretest to posttest (P < 0.001), but t-test demonstrated that improvement in students' CT skills in the experimental group was significantly greater than in the control group after the program (P < 0.001). CONCLUSIONS: Our findings support that concept mapping can be used as a clinical teaching-learning activity to promote CT in nursing students.

Nursing Care Plans Based on NANDA, Nursing Interventions Classification, and Nursing Outcomes Classification: The Investigation of the Effectiveness of an Educational Intervention in Greece.

PURPOSE: The aim of this study was to investigate the effectiveness of an educational intervention on home nursing care plans based on NANDA, Nursing Interventions Classification, and Nursing Outcomes Classification for registered nurses working at primary healthcare settings in Greece. METHODS: This is a quasi-experimental study without a control group. The sample consisted of 19 registered nurses. The study tool was a questionnaire administered pre- and post-educational intervention. FINDINGS: The intervention improved their skills on nursing diagnoses' nomination, proper formulation, and individualization of defining characteristics, but it did not improve them in desired outcomes formulation. CONCLUSIONS: A significant effect of an educational intervention on nursing care plans was demonstrated. IMPLICATIONS FOR NURSING PRACTICE: Nurses' knowledge and attitudes are important for understanding and integrating documentation within the nursing process.

[Problem solving care models for Parkinson's disease]. / Problémamegoldó ápolási-gondozási modell Parkinson-kórban.

INTRODUCTION: Parkinson's disease affects more than 6,3 million people worldwide. Most patients and relatives are left alone to struggle with the symptoms associated with fluctuations in drug levels and the psychotic side effects of the anti-Parkinson's medications. Moreover, quite often even health providers may find difficult to interpret and manage the problems that have been encountered. AIM: The aims of the authors were to analyze systematically the biopsychosocial needs of Parkinson's patients, and to develop a complex, evidence-based Parkinson's-nursing-care model. METHOD: Patients' needs were assessed based on an observational study involving an old patient with Parkinson's disease for more than 28 years. The model has been specified as a multidisciplinary care framework adapted to the special characteristics of Parkinson's disease which transcends the limitations of different standard nursing models. RESULTS: The elaborated model contains a detailed description of cooperative problem solving, which is organized around individual patients along with recommendations for addressing various potential problems that might be encountered. CONCLUSIONS: Implementation of the presented model can improve the life quality of Parkinson's patients and can facilitate the life of affected families provided that these families are well aware about the potential benefits of the novel care delivery system.

How do nurses and ward managers perceive that evidence-based sources are obtained to inform relevant nursing interventions?--an exploratory study.

AIMS AND OBJECTIVES: To explore how nurses and managers perceive that evidence-based sources are obtained to inform relevant nursing interventions. BACKGROUND: Implementation of evidence-based practice requires a systematic search and evaluation of research, clinical expertise and consideration of the patients' preferences and values. Much has been written over the past decade about how this should be done and nurses' mandatory education has provided them with the necessary tools to work in this way. In spite of this, nurses do not provide evidence-based practice on a regular basis. Many of the barriers against evidence-based practice are dependent on contextual factors. Therefore, it can be of interest to study both managers and nurses. DESIGN: This qualitative study has an explorative and retrospective design. METHOD: Interviews were conducted with 15 participants, including eight nurses, four ward managers, two operation managers and one care developer. Directed content analysis was used. RESULT: Nurses and managers had different approaches towards the use of scientific knowledge. Nurses' use of clinical experience and learning from each other was common. Nurses' work as facilitators was structured by managers. Not involving the patient in the care was common among the nurses. CONCLUSION: The parts of evidence-based practice that are supported by the managers are also used by the nurses. When use of research is not controlled by the managers, the nurses do not search for scientific research. Neither is the patients' involvement in decision-making obvious. RELEVANCE TO CLINICAL PRACTICE: A change in nurses' attitudes to scientific knowledge and perception of patient participation is needed. For this to happen, nurses need managers with a strong interest in evidence-based practice that support successful implementation of research in everyday clinical practise.