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.

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.

The design and application of the personalized nursing care plan sheet for critically ill patients in the emergency intensive care unit / 中国实用护理杂志

Objective To investigate the effect of the personalized nursing care plan sheet for critically ill patients in the emergency intensive care unit. Methods The personalized nursing care plan sheet including general, personalized nursing issues and related measures was designed according to the standard from the nursing department. A group of 116 critically ill patients were divided into the observational group (58 patients) and control group (58 patients) from January 2012 to September 2014. The personalized nursing care plan sheet were applied for record and hand over in the observational group, while the unified problem statement nursing care plan sheet were used in the control group. The indicators of nursing quality were observed in the two groups and the nurses′satisfaction with the nursing care plan sheets was compared. Results The nursing quality in the observational group was higher than it in the control group with the lower incidence of failure rate in fundamental nursing, professional nursing, plan sheet, disease treatment and adverse event (32.76% vs. 62.07%,37.93% vs. 67.24%,29.31% vs. 68.97%, 20.69% vs. 53.45%, 10.34% vs. 72.41%, the χ2 values were 2.98, 2.98, 4.09, 3.46 and 6.60 respctively, P<0.05). The nurses′satisfaction with the personalized nursing care plan sheet was also higher than the unified problem statement nursing care plan sheet (P<0.05). Conclusion The incidence of nursing defects could be reduced by avoiding the incomplete nursing assessment and omitted nursing plan.

Cuidado de enfermería para la familia del paciente crítico desde la teoría de la comprensión facilitada / Critical patient's family nursing care from the facilitated sensemaking theory

Introducción: La estancia de un ser querido en la unidad de cuidados intensivos es para la familia una experiencia estresante, traumática y desagradable que se relaciona con enfrentarse a una situación de salud cercana a la muerte, el sufrimiento, la ruptura de roles y el desconocimiento. En este contexto, intervenciones realizadas para que la familia entienda lo que está pasando y lo que debe hacer fomentan la sensación de tranquilidad, confort, seguridad; favorece la adaptación y previene resultados psicológicos adversos. Objetivo: Elaborar una propuesta de gestión que permita desde la teoría brindar cuidado de calidad y excelencia a la familia de los pacientes en cuidado crítico. Metodología: Análisis y aplicación de la teoría de la comprensión facilitada desde la perspectiva del Sistema Conceptual-Teórico-Empírico y el modelo de marco lógico. Resultado: Se presenta un plan de cuidados de enfermería que, hecho desde la teoría de la comprensión facilitada y las taxonomías NANDA, NIC, NOC, muestra aspectos inherentes a la valoración, resultados e intervenciones de cuatro diagnósticos prioritarios de las posibles situaciones más frecuentes que la familia debe enfrentar cuando un ser querido está en una condición crítica de su salud. Conclusión: Un plan de cuidados estandarizado basado en la teoría de la comprensión facilitada es una estrategia de aplicación del conocimiento de enfermería que (1) consolida un modelo de atención integral que favorece la visibilidad, continuidad, eficiencia, calidad y excelencia del cuidado, y (2) disminuye la hostilidad que para los familiares de los pacientes genera la experiencia del cuidado intensivo.

Introduction: The admission of a loved one into an intensive care ward is a very tense, traumatic, and disagreeable experience for the family, and is associated with a challenge to near death situations, suffering, role rupture and even ignorance. Within this context, nursing interventions, in order that the family may have a better understanding of the situation and what they should do. They should also promote the feelings of tranquility, security, comfort, and favor the adaptation, thus preventing adverse psychological results. Objective: To design a management proposal which, based on this theory, could allow giving care of quality and excellence to the families of patients in critical status. Methodology: Analysis and establishment of the facilitated sensemaking theory from the perspective of the Theoretical-Empirical-Conceptual system, and the logical frame model. Results: A nursing care plan is presented which, formulated from the facilitated sensemaking theory and the NANDA, NIC, NOC taxonomies, shows issues related to the assessment, results, and interventions in four priority evaluations of the possible more frequent situations which the family must face when a loved one is in a critical health status. Conclusion: A standardized care plan based on the facilitated sensemaking theory is a strategy to implement nursing knowledge that: 1) consolidates an integral care model which favors the visibility, continuity, efficiency, and excellence of care; 2) reduces the hostility experience by the patient's family from the intensive care situation.

Proceso de atención de Enfermería a pacientes con gangrena de Fournier / Nursing attention process in a Fournier gangrene patient

La gangrena de Fournier es un complejo no muy común y potencialmente letal descrito por Baurienne en 1764, y posteriormente por A. L. Fournier en 1883, como un proceso gangrenoso de causa desconocida; ha adoptado varios nombres como: gangrena idiopàtica, erisipela gangrenosa y gangrena estreptocócica del escroto. Es una patología que ha sido descrita en hombres y mujeres, con alta morbimortalidad especialmente entre los pacientes de 40 a 70 años, que tienen factores predisponentes como (diabetes mellitus y alcoholismo crónico), su incidencia es de 1 en 7,500 casos. Se caracteriza por el inicio abrupto de una infección necrotizante de los tejidos blandos de la región genital y perirectal, progresiva, que compromete tejidos circundantes. El personal de Enfermería en el desarrollo de su función asistencial y en búsqueda de resolver las necesidades humanas de los pacientes, emplean una metodología propia como el Proceso Atención de Enfermería (PAE) y la implementación del Plan de Cuidados de Enfermería (PLACE), como método sistemàtico y organizado para brindar cuidado individualizado y holístico, este proporciona una directriz en el cual se utilizan las competencias, el conocimiento y habilidades. El objetivo fue identificar las necesidades humanas afectadas de un paciente con gangrena de Fournier a través de la valoración de los patrones funcionales, y mejorar la calidad del cuidado empleando la taxonomía NANDA, NOC , NIC.

Fournier gangrene is a complex, not common, but potentially fatal necrotizing infection which was first described by Baurienne in 1764, and later by J. A. Fournier in 1883 as a gangrenous process of unknown etiology. It has been named also as idiopathic gangrene, gangrenous erysipelas, and scrotum streptococcal gangrene. It is both a male and female pathology with a high mortality rate, especially among patients over 40 years old with predisposing factors such as diabetes mellitus and chronic alcoholism. Its incidence is 1 in 7 500 cases. It is characterized by a sudden necrotizing infection of the soft tissues of the genital and perirectal areas, which progressively compromises other surrounding tissues. The nursing staff in the development of their caring role and solve human needs of patients have a right to use a proprietary methodology as the Nursing Care Process (SAP), and the implementation of the Nursing Care Plan (PLACE by its Spanish initials), as organized, systematic approach to provide individualized, holistic care, this provides a guideline that uses the skills, knowledge and abilities. Objective: To identify human needs of a patient affected with Fournier's gangrene through the assessment of functional patterns and improve the quality of care using the taxonomy NANDA, NOC, NIC.

Etiquetas diagnósticas más frecuentes en personas con lesión medular en fase de rehabilitación / Nursing diagnosis tags most frequently performed for spinal cord injury people in rehabilitation phase

Los diagnósticos de Enfermería desde el punto de vista de la gestión del cuidado pueden ser utilizados como criterios clave conceptuales alrededor de los cuales se desarrollan estándares; como es el caso de los planes de cuidado estandarizado. La finalidad del estudio fue identificar las etiquetas diagnósticas de Enfermería más frecuentes en personas con LM en fase de rehabilitación en el servicio de Lesionados Medulares. Metodología: Estudio descriptivo; observacional; transversal; muestra: Estuvo integrada por 90 registros realizados por las enfermeras del servicio. La recolección de datos se realizó a través de un instrumento para identificar las etiquetas diagnósticas más frecuentes de la persona con lesión medular de acuerdo a la Taxonomía de la Asociación Norteamericana de Diagnósticos de Enfermería (2005-2006). Para el análisis se utilizó estadística descriptiva. Los resultados obtenidos fueron:Deterioro de la movilidad física; riesgo de deterioro de la integridad cutánea; déficit de autocuidado: Baño; vestido; deterioro de la integridad cutánea; estreñimiento; incontinencia urinaria refleja; incontinencia fecal; limpieza ineficaz de las vías aéreas; disrreflexia autonómica; deterioro de la habilidad para la traslación y otros. Con base en los resultados obtenidos se identificarán las intervenciones de Enfermería y los resultados esperados a pacientes con lesión medular.

The purpose of this study was to identify the most frequently nursing diagnosis tags in people with spinal Cord Injury (SCI) in rehabilitation process at Spinal cord Injured Ward. Methodology, this is a descriptive, observational, transversal; simple: integrated by 90 clinical nursing records performed by nursing staff. The data collection was performed through a specific instrument in order to identify the most frequently nursing diagnosis tags for the SCI people according to the North American Nursing Diagnosis Association Taxonomy (2005- 2006). Data were analyzed with descriptive statistical techniques. The results were: physical movement impairment, skin integrity damage risk, self-care deficit: bathing, dressing; skin integrity damage, constipation, reflex urinary tract incontinence, fecal incontinence, ineffective clean up of the airways, autonomic dysreflexia, impairment of the ability to pass and others diagnosis. Based on the results, the Nursing Interventions and the Nursing Outcomes will be identified specifically for SCI patients.

An Attitude Survey for Nursing Care Managers on Acupuncture and Moxibustion Therapy in Nursing Care Plans / 全日本鍼灸学会雑誌

[Purpose]To investigate the present use of medical expenses for acupuncture and moxibustion, and judo and massage therapies under the health insurance system in contracted nursing care plans prepared by nursing care managers.<BR>[Methods]The subjects were 75 nursing care service providers who were registered in a certain municipally (B City) with an aging index of 27.7%. We investigated the experience and use of medical expenses for acupuncture and moxibustion therapy through a mail survey. The survey period was from July 10 to July 31 in 2006. The collection rate was 57.3%(43out of 75 nursing care service providers). We used simple adding, the Kruskal-Wallis test, factor analysis (principal factor method) and path analysis.<BR>[Results]In simple adding, there were 3,535 total care receivers, 11.5%of the total aged population in B City. Users who took acupuncture and moxibustion therapy were 2.5%of the total care receivers in nursing care plans. However, 10 people could not take acupuncture and moxibustion therapy due to their economic conditions. Nine out of 41 nursing care service providers (22.0%) had users who could not take acupuncture and moxibustion therapy because their healthcare facilities would not sign the written informed consent. In factor analysis (principal factor analysis), "experience and recognition of acupuncture and moxibustion therapy using medical expenses"was extracted as the first principal component. In pass analysis, it can be explained that nursing care managers who planned acupuncture and moxibustion therapy using medical expenses had recognized that the therapy would maintain the capabilities for activities of daily living (ADL) and quality of life (QOL) of the users.<BR>[Conclusion]When nursing care managers planned acupuncture and moxibustion therapy for maintenance of ADL and QOL in their care services using medical expenses, they were considered to have recognized that the therapy would keep the users'ADL and QOL.