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.

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.

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.

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.

Implementation and testing of the OPT Model as a teaching strategy in an undergraduate psychiatric nursing course.

Teaching undergraduate nursing students to think critically and reason clinically is a challenge for nurse educators, yet these skills are essential for the professional nurse. The Outcome-Present State-Test (OPT) Model of Reflective Clinical Reasoning (Pesut & Herman, 1999) provides a framework for teaching clinical reasoning skills to nursing students. This article describes how the model can be used in clinical teaching of undergraduate students in psychiatric and mental health settings and presents some findings from an evaluation of the model. Strategies employed in the model implementation are described, along with the benefits and limitations of this teaching method in a psychiatric clinical setting.

Do-not-resuscitate. Orders in surgery: decreasing the confusion.

Patients have the right to make decisions regarding their medical care, including the right to refuse treatment or to issue do-not-resuscitate orders as part of an advance directive. Health care providers must comply with the patient's wishes regarding care. Automatic suspension or continuation of a do-not-resuscitate order for a patient undergoing surgery cannot be justified. Surgical team members should consult with the patient and, if necessary, with an ethics expert or committee to determine whether the do-not-resuscitate order is to be maintained or completely or partially suspended during anesthesia and surgery. All surgical departments should have a written policy and procedure concerning the treatment of patients with do-not-resuscitate orders.

[Concerning the development of nursing diagnostics, what are the accompanying dynamics?]. / Autour de la formation aux diagnostics infirmiers, quelle dynamique d'accompagnement?

To insure that they are carried out in medical establishments, nursing diagnostics have been taught in Nursing Training Institutes since 1992. This innovative practice, which is now included in new study programmes, is a logical step to increase the responsibility of the nursing profession. The acknowledgement of this new role for the nursing profession enables nurses to free themselves from the essentially curative model. However, this innovation, borrowed from the Anglo-Saxons, doesn't seem to be welcomed and fully taken up by all in the medical professions. The purpose of this thesis is to examine the use being made of this by the medical professions in order to provide new realistic nursing programmes. It also tries to look at teaching and tutoring practices to achieve a greater competency in nursing diagnostics. It attempts to highlight the diverging reactions of the nursing and teaching professionals having to deal with these changes. And finally, it seeks to identify a favourable environment which would lead to an even greater professionalisation of both individual and collective.

Implementing nursing diagnostics effectively: cluster randomized trial.

AIM: This paper is a report of a study to investigate the effect of guided clinical reasoning. This method was chosen as a follow-up educational measure (refresher) after initial implementation of standardized language. BACKGROUND: Research has demonstrated nurses' need for education in diagnostic reasoning to state and document accurate nursing diagnoses, and to choose effective nursing interventions to attain favourable patient outcomes. METHODS: In a cluster randomized controlled experimental study, nurses from three wards received guided clinical reasoning, an interactive learning method. Three wards, receiving classic case discussions, functioned as control group. Data were collected in 2004-2005. The quality of 225 randomly selected nursing records, containing 444 documented nursing diagnoses, corresponding interventions and outcomes was evaluated by applying 18 Likert-type items with a 0-4 scale of the instrument Quality of Nursing Diagnoses, Interventions and Outcomes. The effect of guided clinical reasoning was tested against classic case discussions using T-tests and mixed effects model analyses. FINDINGS: The mean scores for nursing diagnoses, interventions and outcomes increased significantly in the intervention group. Guided clinical reasoning led to higher quality of nursing diagnosis documentation; to aetiology-specific interventions and to enhanced nursing-sensitive patient outcomes. In the control group, the quality was unchanged. CONCLUSION: Guided clinical reasoning supported nurses' abilities to state accurate nursing diagnoses, to select effective nursing interventions and to reach and document favourable patient outcomes. The results support the use of the North American Nursing Diagnosis Association, Nursing Interventions Classification and Nursing Outcomes Classification classifications and demonstrate implications for the electronic nursing documentation.

Therapeutic enhancement: nursing intervention category for patients diagnosed with Readiness for Therapeutic Regimen Management.

AIMS: To present a new nursing intervention category called therapeutic enhancement. BACKGROUND: Fewer than half of North Americans follow their physician's recommendations for diet and exercise, even when such are crucial to their health or recovery. It is imperative that nurses consider new ways to promote healthy behaviours. Therapeutic enhancement is intended to provide such a fresh approach. Traditional intervention techniques focusing on education, contracts, social support and more frequent interaction with physicians appear not to be effective when used alone. Successful strategies have been multidisciplinary; and have included interventions by professional nurses who assist patients to understand their disease and the disease process and that helps them to develop disease-management and self-management skills. Therapeutic enhancement incorporates The Stages of Change Theory, Commitment to Health Theory, Motivational Interviewing techniques and instrumentation specifically designed for process evaluation of health-promoting interventions. METHOD: This is a critical review of approaches that, heretofore, have not been synthesised in a single published article. CONCLUSIONS: Based on the commonly used Stages of Change model, therapeutic enhancement is useful for patients who are at the action stage of change. Using therapeutic enhancement as well as therapeutic strategies identified in Stages of Change Theory, such as contingency management, helping relationships, counterconditioning, stimulus control and Motivational Interviewing techniques, nursing professionals can significantly increase the chances of patients moving from action to the maintenance stage of change for a specific health behaviour. RELEVANCE TO CLINICAL PRACTICE: Using the nursing intervention category, therapeutic enhancement can increase caregivers' success in helping patients maintain healthy behaviours.

Evaluation of the Outcome-Present State Test Model as a way to teach clinical reasoning.

The Outcome-Present State Test (OPT) Model of Clinical Reasoning is a nursing process model designed to help students develop clinical reasoning skills. Although many nurse educators are using the OPT model as a teaching strategy, few are formally evaluating its use as a method. We used the OPT model as a teaching tool in an undergraduate psychiatric and mental health clinical nursing course and evaluated how quickly students became adept at using it. Most students mastered the use of the model; 29 of 43 students achieved the criterion score (a score greater than 65 on 3 or more models completed over 4 weeks). Not only did the students gain clinical reasoning skills, but they also used and learned more about the North American Nursing Diagnosis Association, Nursing Interventions Classification, and Nursing Outcomes Classification languages. Recommendations for future use of the model include adding client strengths and increasing focus on the quality of students' responses.

Unilateral neglect: assessment in nursing practice.

The North American Nursing Diagnosis Association has recognized unilateral neglect (UN) as a nursing diagnosis for more than 2 decades. Such a designation implies that nurses primarily are responsible for assessing, treating, and researching the disorder. However, nurses have made few documented contributions toward this responsibility. Although UN is a complex problem that requires attention from several specialties, there is room for nurses to substantially increase their role. Nurses are uniquely positioned to assess and treat UN by virtue of their interaction with patients in a variety of times, settings, and activities. Nurses need to develop quantifiable measures of clinical observation that are reliable and valid in nursing practice. This article reviews the literature to examine the impact of UN, existing assessment methods, and nursing involvement in assessment and treatment. Potential nursing contributions in practice and research are featured as well.

Nursing diagnosis: is it time for a new definition?

PURPOSE: The Diagnosis Development Committee (DDC) of NANDA International frequently receives proposed "physiologic" and "surveillance diagnosis" submissions that may not meet the current definition of nursing diagnosis (NANDA, 2007, p. 332). There has been a request for a vote on newly proposed definitions of nursing diagnosis, risk diagnosis, and syndromes. The purpose of this article is to provide information which enables members and interested nurses to continue the dialogue and to share their thoughts and also to consider the thoughts and information generated by the participants in the NANDA-I interest survey on the definition of nursing diagnoses. DATA SOURCES: An electronic survey of the current NANDA-I definitions, and potential changes to those definitions, was distributed via the NANDA-I Web site. This article summarizes the overall findings of that survey and provides an overview of commentary received from the 269 participants. CONCLUSIONS: It is necessary to continue the dialogue on this important decision and to provide a mechanism for input from members and interested nurses before reaching any conclusions on this subject. NURSING IMPLICATIONS: NANDA-I has been recognized as the leader in the development and implementation of nursing diagnoses and must act responsibly in assessing the changing and emerging trends in nursing practice and in responding to these trends.

An exemplar of the use of NNN language in developing evidence-based practice guidelines.

PURPOSE: To explore the use of standardized language, NNN, in the development of evidence-based practice (EBP). DATA SOURCES: Published research and texts on family interventions, nursing diagnoses (NANDA-I), nursing interventions (NIC), and nursing outcomes (NOC). DATA ANALYSIS: Research literature was summarized and synthesized to determine levels of evidence for the NIC intervention Family Integrity Promotion. CONCLUSIONS: The authors advocate that a "standards of practice" category of levels of evidence be adopted for interventions not amenable to randomized controlled trials or for which a body of research has not been developed. Priorities for nursing family intervention research are identified. IMPLICATIONS FOR NURSING PRACTICE: The use of NANDA-I nursing diagnoses, NIC interventions, and NOC outcomes (NNN language) as research frameworks will facilitate the development of EBP guidelines and the use of appropriate outcome measures.

Testing the Q-DIO as an instrument to measure the documented quality of nursing diagnoses, interventions, and outcomes.

PURPOSE: To describe pilot testing of Quality of Diagnoses, Interventions and Outcomes (Q-DIO), an instrument to measure quality of nursing documentation. DESIGN: Instrument testing was performed using a random, stratified sample of 60 nursing documentations representing hospital nursing with and without implementation of standardized nursing language (30 for both strata) in a Swiss General Acute Hospital. METHODS: Internal consistency and intrarater and interrater reliabilities were tested. Through item analyses, the grades of difficulty and the discrimination validity of items were evaluated. FINDINGS: Internal consistency of nursing diagnoses as process produced Cronbach's alpha .83; nursing diagnoses as product .98; nursing interventions .90; and nursing-sensitive patient outcomes .99. With Kappas of .95, the intrarater and interrater reliabilities were good. Criteria for the grades of difficulty of items and discrimination validity were well met. The results of this study suggest that Q-DIO is a reliable instrument to measure the documentation quality of nursing diagnoses, interventions, and outcomes. Further testing of Q-DIO in other settings is recommended.