Clinical validation of the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to cardiac catheterization.

AIM: To validate, clinically, the defining characteristics for the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to heart catheterization and to validate acute pain, haematoma, bleeding, redness, and heat as additional characteristics. BACKGROUND: In clinical practice, an applicable nursing diagnosis for patients subjected to diagnostic heart catheterization has not been well-defined. DESIGN: Cross-sectional. METHODS: This clinical validation study using Fehring's model was performed at a Brazilian general hospital between November 2009-November 2010. This study included 250 patients who received elective femoral artery catheterization. Each patient was identified as having two characteristics of Impaired Tissue Integrity and three characteristics of Impaired Skin Integrity, according to NANDA-I nursing diagnoses. Due to certain postprocedure events, five additional characteristics were added to be validated in this setting. In addition to Fehring's reliability rating, the kappa coefficient was used to evaluate inter-rater agreement during the clinical evaluation. RESULTS: The defining characteristic of damaged tissue was validated for Impaired Tissue Integrity and the defining characteristics of the invasion of body structures and the disruption of the skin surface were validated for Impaired Skin Integrity. Although the five characteristics that were added to the investigated diagnoses were not validated because of their low rate of occurrence in this setting, the measurements of acute pain, haematoma, bleeding, redness, and heat each had excellent inter-rater agreement. CONCLUSION: The validation of characteristics from both of these diagnoses suggested that these criteria could be utilized for clinical practice in a diagnostic setting. Moreover, additional characteristics should also be observed to better guide nursing intervention.

[Implementation of nursing diagnosis in intensive care units: a periodic review]. / Implantação do diagnóstico de enfermagem em unidade de terapia intensiva: uma análise periódica.

Knowledge about the prevalence of nursing diagnosis (ND) helps to provide the necessary care and to guide continuing education programs. This cross-sectional study aimed to identify the main nursing diagnosis (ND) prescribed in intensive care units (ICU) and to compare them with medical and surgical patients. Data analysis was performed according to the North American Nursing Diagnoses Association (NANDA) Taxonomy II. In the 150 medical records evaluated were found 195 nursing diagnoses, with an average of 1.3 per patient, mainly in the protection and security domain (39.5%). The most common ND were: impaired tissue integrity (22%), impaired gas exchange (22%), ineffective cerebral tissue perfusion (8.7%), impaired skin integrity (7.7%), decreased cardiac output (6.7%) and ineffective tissue perfusion cardiopulmonary (6.1%). The most prevalent nursing diagnoses revealed the physiological needs as the most common in our sample.

Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study.

OBJECTIVE: to analyze vascular complications among patients who underwent endovascular cardiac procedures in the hemodynamic laboratories of three referral centers. METHOD: a multicenter cohort study was conducted in three referral facilities. The sample was composed of 2,696 adult patients who had undergone elective or urgent percutaneous cardiac procedures. The outcomes were vascular complications, such as: hematoma at the site of the arterial puncture; major or minor bleeding; surgical correction for retroperitoneal hemorrhage; pseudoaneurysm; and arteriovenous fistula. RESULTS: 237 (8.8%) of the 2,696 patients presented a vascular complication at the site of the arterial puncture. The total number of vascular complications was 264: minor hematoma<10cm (n=135); stable bleeding (n=86); major hematoma ≥10cm (n=32); and unstable bleeding (n=11). There were no retroperitoneal hematoma events, pseudoaneurysm or arterial venous fistula. Most of the major and minor complications occurred in the first six hours after the procedure. CONCLUSION: the results concerning the current context of interventional cardiology indicate that the complications predominantly occur in the first six hours after the procedure, considering a 48-hour follow-up. The staff should plan and implement preventive measures immediately after the procedures.

Nursing Interventions and Outcomes for the Diagnosis of Impaired Tissue Integrity in Patients After Cardiac Catheterization: Survey.

PURPOSE: Determine the outcomes and interventions for patients undergoing cardiac catheterization with nursing diagnosis of impaired tissue integrity. METHODS: Survey with e-questionnaires sent for expert nurses in two rounds. FINDINGS: Only one nursing outcome was approved: tissue integrity-skin and mucosa and five related interventions, namely, pressure control, topical drug administration, care of incision site, care of injuries, and infection control. CONCLUSIONS: The expected outcomes and the most significant interventions for the implementation of nursing care during the immediate recovery of patients with impaired tissue integrity following invasive hemodynamic procedures were defined. IMPLICATIONS FOR NURSING PRACTICE: The study findings support selection of appropriate nursing outcomes and interventions for this patient profile.

Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study / Complicações vasculares em pacientes submetidos a procedimentos cardiológicos endovasculares: coorte multicêntrica / Complicaciones vasculares en pacientes sometidos a procedimientos cardiológicos endovasculares: cohorte multicéntrica

ABSTRACT Objective: to analyze vascular complications among patients who underwent endovascular cardiac procedures in the hemodynamic laboratories of three referral centers. Method: a multicenter cohort study was conducted in three referral facilities. The sample was composed of 2,696 adult patients who had undergone elective or urgent percutaneous cardiac procedures. The outcomes were vascular complications, such as: hematoma at the site of the arterial puncture; major or minor bleeding; surgical correction for retroperitoneal hemorrhage; pseudoaneurysm; and arteriovenous fistula. Results: 237 (8.8%) of the 2,696 patients presented a vascular complication at the site of the arterial puncture. The total number of vascular complications was 264: minor hematoma<10cm (n=135); stable bleeding (n=86); major hematoma ≥10cm (n=32); and unstable bleeding (n=11). There were no retroperitoneal hematoma events, pseudoaneurysm or arterial venous fistula. Most of the major and minor complications occurred in the first six hours after the procedure. Conclusion: the results concerning the current context of interventional cardiology indicate that the complications predominantly occur in the first six hours after the procedure, considering a 48-hour follow-up. The staff should plan and implement preventive measures immediately after the procedures.

RESUMO Objetivo: analisar as complicações vasculares de pacientes submetidos a procedimentos cardiológicos endovasculares em laboratório de hemodinâmica de três centros de referência. Método: estudo de coorte multicêntrico, em três instituições de referência, sendo a amostra constituída de 2.696 pacientes, incluindo pacientes adultos que realizaram procedimento percutâneo cardiológico em caráter eletivo ou urgente. Foram considerados como desfechos a presença de complicações vasculares, como hematoma no local da punção arterial, sangramento maior e menor e correção cirúrgica para hemorragia retroperitoneal, pseudoaneurisma ou formação de fístula arteriovenosa. Resultados: dos 2.696 pacientes, 237 (8,8%) apresentaram algum tipo de complicação vascular no sítio de punção arterial. O número total de complicações vasculares foi 264: hematoma menor <10 cm (n=135), sangramento estável (n=86), hematoma maior ≥10 cm (n=32) e sangramento instável (n=11). Não ocorreu evento de hematoma retroperitoneal, pseudoaneurisma ou fístula arteriovenosa. Majoritariamente, tanto as complicações maiores como as menores ocorreram nas primeiras seis horas após o procedimento. Conclusão: os resultados das complicações no cenário atual da cardiologia intervencionista indicam que a incidência dessas ocorre predominantemente nas primeiras seis horas após os procedimentos, considerando a avaliação até 48 horas. Medidas preventivas imediatas aos procedimentos devem ser planejadas e implementadas pela equipe.

RESUMEN Objetivo: analizar las complicaciones vasculares de pacientes sometidos a procedimientos cardiológicos endovasculares en laboratorio de hemodinámica, en tres centros de referencia. Método: fue diseñado un estudio de cohorte multicéntrica en tres instituciones de referencia. La muestra estuvo constituida por 2.696 pacientes; fueron incluidos pacientes adultos que realizaron procedimiento percutáneo cardiológico en carácter electivo o urgente; los que fueron considerados como resultado de la presencia de complicaciones vasculares, como: hematoma en el local de la punción arterial; hemorragia mayor y menor y corrección quirúrgica para hemorragia retroperitoneal, pseudoaneurisma o formación de fístula arterial venosa. Resultados: de los 2.696 pacientes, 237(8,8%) presentaron algún tipo de complicación vascular en el sitio de la punción arterial. El número total de complicaciones vasculares fue 264: hematoma menor <10cm (n=135), hemorragia estable (n=86), hematoma mayor ≥10cm (n=32) y hemorragia inestable (n=11). No ocurrió evento de hematoma retroperitoneal, pseudoaneurisma o fístula arterial venosa. En su mayoría, tanto las complicaciones mayores como las menores ocurrieron en las primeras seis horas después del procedimiento. Conclusión: los resultados de las complicaciones, en el escenario actual de la cardiología intervencionista, indican que la incidencia de ellas ocurre predominantemente en las primeras seis horas después de los procedimientos, considerando la evaluación hasta 48h. Medidas preventivas inmediatas a los procedimientos deben ser planificadas e implementadas por el equipo.

A clinical validation study of impaired physical mobility of patients submitted to cardiac catheterization.

PURPOSE: To conduct a Fehring model-based clinical validation of the defining characteristics of the nursing diagnosis of impaired physical mobility in a sample of 250 patients. METHOD: Cross-sectional study. FINDINGS: Three of the 11 NANDA-International defining characteristics assessed in this study were validated: limited range of motion, limited ability to perform gross motor skills, and difficulty turning. Although discomfort was not validated due to the rarity of occurrence, there was excellent interrater agreement as to its relevance (kappa coefficient). CONCLUSIONS: In this setting, three characteristics were validated. IMPLICATIONS FOR NURSING PRACTICE: Validation studies are important for advancing evidence-based practice.

Factors that inhibit the use of nursing language.

PURPOSE: The purpose of this study was to identify the impact of institutional, professional, and personal factors on nurses and on their efforts to make nursing diagnoses. METHODS: A cross-sectional study was conducted in which all participants completed a questionnaire established to measure each individual group of factors. A score (0-100) was established to measure each group of factors. RESULTS: Twenty-one nurses responded that their busy shifts, the number of patients per nurse, and their involvement with administrative tasks were the three parameters most frequently identified as interfering with implementing nursing diagnosis. CONCLUSION: The recognition of these factors and improved institutional support may facilitate the implementation of nursing diagnoses. PRACTICE IMPLICATIONS: Electronic records may contribute to the implementation of the nursing process, particularly if the identified signs and symptoms are documented and then linked to nursing diagnoses and interventions.

Intervenções de enfermagem implementadas de acordo com os diagnósticos mais prevalentes em intensivismo: estudo transversal / Intervenciones de enfermería aplicada de acuerdo con el diagnóstico más frecuente em intensivismo: estudio transversal / Nursing interventions implemented according to the most prevalent nursing diagnoses in intensive care: cross-sectional study

Evaluating clinical practice based on standard language has become a necessity. OBJECTIVE: This study aims to map nursing interventions according to the Nursing Interventions Classification (NIC), identifying the most prevalent Nursing Diagnoses in an intensive care unit within the first 24 hours of hospital admission. METHOD: Cross-sectional study. A cross-mapping method was used to analyze data collected from 150 medical records. A total of 195 diagnoses were identified, showing 21 different ones; and 1694 prescribed care. RESULT: The most recurrent diagnoses were Impaired Tissue Integrity and Impaired Skin Integrity, and the main intervention, Lesion Care (14.1% and 19.78%) was prescribed for both; Gas Exchange was affected by prevailing intervention Airway Control (29.76%), Ineffective Tissue Perfusion: cerebral and cardiopulmonary with priority intervention Neurologic Monitoring (38.3%) and Acute Cardiac Care (2.8%) respectively, the latter also being priority for Decreased Cardiac Output (1.3%). CONCLUSION: Most care was in line with the standard taxonomy of the Nursing Interventions Classification, though the interventions considered priority were limited...

A avaliação clínica baseada em linguagem padrão tornou-se uma necessidade. OBJETIVO: Mapear as intervenções implementadas pelos enfermeiros segundo a Nursing Interventions Classification aos diagnósticos de enfermagem mais prevalentes em unidade de terapia intensiva de um hospital universitário, nas primeiras 24 horas de admissão dos pacientes. MÉTODO: Estudo transversal. O mapeamento cruzado foi utilizado para análise dos dados de 150 prontuários, totalizando 195 diagnósticos e 1694 cuidados prescritos. RESULTADOS: Os diagnósticos mais prevalentes foram Integridade Tissular Prejudicada e Integridade da Pele Prejudicada, a intervenção prioritária Cuidado com lesões (14,1% e 19,78%) foi prescrita para ambos; Troca da Gases prejudicada com a intervenção prioritária Controle de Vias aéreas (29,76%), Perfusão Tissular ineficaz: cerebral e cardiopulmonar com a intervenção prioritária Monitorização Neurológica (38,3%) e Cuidados Cardíacos na fase aguda (2,8%) respectivamente, esta última prioritária também para Débito Cardíaco Diminuído (1,3%). CONCLUSÃO: A maioria dos cuidados estava relacionada com a taxonomia padrão da Nursing Interventions Classification, porém as intervenções consideradas prioritárias foram limitadas...

La evaluación de la práctica clinica basada en la lengua estándar ha convertido en una necesidad. OBJETIVO: Trazar intervenciones realizado por enfermeras de acuerdo con Nursing Interventions Classification en los diagnosticos de enfermería más prevalentes en la unidade de cuidados intensivos en hospital universitario, en las primeras 24 horas de la admisión de los pacientes. MÉTODO: Estudio transversal. Fue utilizado mapeamento cruzado para análisis de datos. Se analizó expedientes médicos de 150 pacientes, total 195 diagnosticos y 1694 cuidados prescritos. Los diagnosticos más prevalentes fueron Deterioro del tejido Integridad, Alteración integridad cutánea, la intervención prioritaria Cuidado con lesiones (14,1% y 19,78%) fue prescrita para ambos; Cambio de gases intervención prioritaria Control de la vía aérea afectada (29,76%), Perfusión tisular inefectiva: cardiopulmonar y cerebral la intervención del seguimiento prioritario neurológicas (38,3%), Cuidados Cardíacos fase aguda (2,8%), respectivamente, este último una prioridad para la Disminución del gasto cardiaco (1,3 %). CONCLUSIÓN: La mayoria de la atención está relacionada con la taxonomía Nursing Interventions Classification, pero intervenciones prioritarias fueron limitadas...

Implantação do diagnóstico de enfermagem em unidade de terapia intensiva: uma análise periódica / Aplicación de diagnóstico de enfermería en la unidad de cuidados intensivos: una revisión periódica / Implementation of nursing diagnosis in the intensive care unit: a periodic review

O conhecimento acerca da prevalência dos diagnósticos de enfermagem (DE) contribui para a previsão dos cuidados necessários e para a orientação de programas de educação permanente. Estudo com delineamento transversal, que teve por objetivo identificar os principais DE de uma unidade de terapia intensiva (UTI), comparando-se as diferentes categorias entre os pacientes clínicos e cirúrgicos. A análise dos dados foi realizada de acordo com a taxonomia II da North American Nursing Diagnoses Association (NANDA). Nos 150 prontuários avaliados foram encontrados 195 diagnósticos, com uma média de 1,3 DE por paciente, majoritariamente do domínio segurança e proteção (39,5 por cento). Os DE mais freqüentes foram: integridade tissular prejudicada (22 por cento), troca de gases prejudicada (22 por cento), perfusão tissular ineficaz cerebral (8,7 por cento), integridade da pele prejudicada (7,7 por cento), débito cardíaco diminuído (6,7 por cento) e perfusão tissular ineficaz cardiopulmonar (6,1 por cento). Os DE mais prevalentes denotam as necessidades fisiológicas como as mais comuns na amostra estudada.

El conocimiento acerca de la prevalencia de los diagnósticos de enfermería (DE) ayuda a brindar la atención necesaria y la orientación de los programas de educación continua. Estudio que identifico los principales DE prescrito en la unidad de cuidados intensivos (UCI) y compararlos entre pacientes médicos y quirúrgicos. Análisis de los datos se realizó de acuerdo a la taxonomía II de la North American Nursing Diagnoses Association (NANDA). En las 150 cartas evaluados fueron encontrados 195 diagnósticos, con un promedio de 1,3 por paciente, principalmente en el campo y la seguridad (39,5 por ciento). Los DE más comunes fueron: deterioro de la integridad tisular (22 por ciento), deterioro del intercambio gaseoso (22 por ciento), ineficacia de la perfusión tisular cerebral (8,7 por ciento), alteración de la integridad cutánea (7,7 por ciento), disminución del gasto cardíaco (6 , 7 por ciento) y la perfusión tisular inefectiva cardiopulmonar (6,1 por ciento). Lo más frecuentes DE reflejan las necesidades fisiológicas como las más comunes en nuestra muestra.

The knowledge about the prevalence of nursing diagnosis (ND) helps to provide the necessary care and guidance of continuing education programs. This cross-sectional study aimed to identify the main DE prescribed in the intensive care unit (ICU) and compare them between medical and surgical patients. Data analysis was performed according to the North American Nursing Diagnoses Association (NANDA) Taxonomy II. In the 150 medical records evaluated were found 195 nursing diagnoses, with an average of 1,3 per patient, mainly in the field and security domain (39,5 percent). The most common ND were: impaired tissue integrity (22 percent), impaired gas exchange (22 percent), ineffective cerebral tissue perfusion (8,7 percent), impaired skin integrity (7,7 percent), decreased cardiac output (6,7 percent) and ineffective tissue perfusion cardiopulmonary (6,1 percent). Nursing diagnosis most prevalent denote the physiological needs as the most common in our sample.