NANDA-I® nursing diagnoses in adult critical patients with COVID-19 / Diagnósticos de enfermagem da NANDA-I® em pacientes críticos adultos portadores de COVID-19 / Diagnósticos en enfermería de NANDA-I® en pacientes críticos adultos con COVID-19

Resumo Objetivo Identificar possíveis diagnósticos de enfermagem conforme a classificação da NANDA-International presentes em pacientes críticos adultos portadores de COVID-19 a partir de pistas diagnósticas descritas pela literatura científica. Métodos Estudo descritivo, desenvolvido em três etapas: revisão de literatura e agrupamento das pistas diagnósticas identificadas de acordo com as Necessidades Humanas Básicas; levantamento dos diagnósticos de enfermagem da NANDA-International a partir da correspondência entre as pistas diagnósticas descritas pela literatura com o título e indicadores diagnósticos; validação da correspondência diagnóstica por enfermeiros peritos. Foi utilizado o índice de concordância ≥ 0,80. Resultados A partir da leitura de 20 estudos, elegeram-se 51 pistas diagnósticas que foram agrupadas em 11 Necessidades Humanas Básicas Psicobiológicas. Após três rodadas de análise pelos peritos, identificou-se correspondência das 51 pistas diagnósticas com 26 títulos diagnósticos de enfermagem da NANDA-International. Os domínios dessa classificação com maior número de diagnósticos foram: atividade/repouso (n=9); segurança/proteção (n=7) e nutrição (n=4). Ressalta-se que 45,1% das pistas diagnósticas apresentaram correspondência com mais de um título diagnóstico. Além disso, a maioria dos diagnósticos de enfermagem (60,0%) refere-se a problemas reais e 40,0% a problemas potenciais. Conclusão Os resultados obtidos permitiram a identificação de pistas diagnósticas presentes em pacientes críticos adultos portadores de COVID-19 e verificar sua equivalência com 26 títulos diagnósticos da NANDA-International.

Resumen Objetivo Identificar posibles diagnósticos en enfermería según la clasificación de NANDA-International presentes en pacientes críticos adultos con COVID-19 a partir de pistas diagnósticas que se describen en la literatura científica. Métodos Estudio descriptivo, desarrollado en tres etapas: revisión de literatura y agrupación de las pistas diagnósticas identificadas de acuerdo con las Necesidades Humanas Básicas; recopilación de los diagnósticos de enfermería de NANDA-International a partir de la correspondencia entre las pistas diagnósticas que se describen en la literatura con el título e indicadores diagnósticos; validación de la correspondencia diagnóstica por enfermeros expertos. Se utilizó el índice de coincidencia ≥ 0,80. Resultados A partir de la lectura de 20 estudios, se eligieron 51 pistas diagnósticas que se agruparon en 11 Necesidades Humanas Básicas Psicobiológicas. Después de tres rondas de análisis de los expertos se identificó la correspondencia de las 51 pistas diagnósticas con 26 títulos diagnósticos de enfermería de NANDA-International. Los dominios de esa clasificación con un mayor número de diagnósticos fueron: actividad/reposo (n=9); seguridad/protección (n=7) y nutrición (n=4). Se destaca que 45,1 % de las pistas diagnósticas presentaron correspondencia con más de un título diagnóstico. Además, la mayoría de los diagnósticos de enfermería (60,0 %) se refiere a problemas reales y el 40,0 % a problemas potenciales. Conclusión Los resultados alcanzados permitieron la identificación de pistas diagnósticas presentes en pacientes críticos adultos con COVID-19 y verificar su equivalencia con 26 títulos diagnósticos de NANDA-International.

Abstract Objective To identify possible nursing diagnoses according to the NANDA-International classification present in critically ill adult patients with COVID-19 based on diagnostic clues described in the scientific literature. Method This is a descriptive study, developed in three stages: literature review and grouping of diagnostic clues identified according to Basic Human Needs; survey of NANDA-International nursing diagnoses based on the correspondence between diagnostic clues described in the literature with title and diagnostic indicators; validation of diagnostic correspondence by expert nurses. An agreement index ≥ 0.80 was used. Results From the reading of 20 studies, 51 diagnostic clues were selected and grouped into 11 Psychobiological Basic Human Needs. After three rounds of analysis by the experts, a correspondence of 51 diagnostic clues with 26 NANDA-International nursing diagnosis titles was identified. The domains of this classification with the highest number of diagnoses were: activity/rest (n=9); safety/protection (n=7) and nutrition (n=4). It is noteworthy that 45.1% of the diagnostic clues corresponded to more than one diagnostic title. Moreover, most nursing diagnoses (60.0%) refer to real problems and 40.0% to potential problems. Conclusion The results obtained allowed the identification of diagnostic clues present in critically ill adult patients with COVID-19 and to verify their equivalence with 26 diagnostic titles from NANDA-International.

Accuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients.

OBJECTIVES: to analyze the accuracy of the clinical indicators of ineffective airway clearance in adult intensive care unit patients. METHODS: diagnostic accuracy study, performed in the intensive care unit of a university hospital in northeastern Brazil. The sample consisted of 104 patients hospitalized between June and October 2019. RESULTS: the prevalence of ineffective airway clearance was 36.54%. The indicators with high specificity included absence of cough (0.8326), orthopnea (0.6817), adventitious breath sounds (0.8175), and diminished breath sounds (0.8326). The clinical indicators with high sensitivity and specificity were alteration in respiratory rate (0.9999) and alteration in respiratory pattern (0.9999). CONCLUSIONS: six clinical indicators provided an accurate identification of ineffective airway clearance. The clinical indicators alteration in respiratory rate and alteration in respiratory pattern were the most accurate for critical adult patients. The findings of this study contribute to accurate diagnostic inferences and to prevention of respiratory complications in these patients.

Clinical indicators, nursing diagnoses, and mortality risk in critically ill patients with COVID-19: a retrospective cohort.

OBJECTIVE: To identify clinical indicators and nursing diagnoses with the highest risk of mortality in critically ill patients with COVID-19. METHOD: Retrospective cohort with the population of adults and elderly people with COVID-19 from an Intensive Care Unit. Categorical variables were described using absolute and relative frequencies and risk factors for mortality using Cox regression, with a confidence interval of 95%. RESULTS: The main clinical indicators of COVID-19 patients were dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses at higher risk of mortality were Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation, Acute confusion, Frailty syndrome, Obesity, and Decreased cardiac output. It is worth mentioning that there was little information about the diagnoses of Domains 9, 10, and 12. CONCLUSION: This research infers the need to monitor the clinical indicators dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses with the highest risk of mortality Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation in critically ill patients.

Responses Presented by Adult Patients with COVID-19, Based on the Formulated Nursing Diagnoses: A Scoping Review.

(1) Background: this review aims to identify the human responses exhibited by adult patients with COVID-19, by listing the corresponding nursing diagnoses. Nursing diagnosis it's a clinical analysis of human responses to a person, family, or community. Therefore, it is possible to state that nursing diagnoses represent human responses. (2) Methods: a scoping review was conducted following recommendations provided by the Joanna Briggs Institute (JBI) and the research was carried out between December 2020 and 15 January, 2021, via CINAHL Complete, Complementary Index, MEDLINE, Science Direct, Academic Search Complete, Science Citation Index, Directory of Open Access Journals, Scopus, Social Sciences Citation Index, Business Source Complete, eBook Index (by B-on), and the Cochrane Database of Systematic Reviews (by Cochrane Library). (3) Results: with respect to studies using the NANDA-I taxonomy, the findings have shown that "impaired gas exchange" was the most highlighted nursing diagnosis. ICNP taxonomy, the relevant nursing diagnosis is "cough present". (4) Conclusions: concurrently, as suggested by the human responses documented in this review, throughout the pandemic, the requirements for adequate care provision have been constantly updated, to improve the quality of life of those patients, as much as possible.

Nursing diagnosis related to the coronavirus pandemic infections in the Brazilian population.

OBJECTIVE: To reflect on the nursing diagnoses in individuals, families or collectivity facing the pandemic of COVID-19. METHODS: The Developing Nurses' Thinking model was considered as a theoretical framework, and the phases of critical thinking skills were applied to the identification of nursing diagnoses in the general population in the face of the pandemic. RESULTS: The systematic application of the seven critical thinking skills of the proposed model and the presentation of 13 nursing diagnoses and their respective indicators were performed. FINAL CONSIDERATIONS: It is necessary to recognize the importance of incorporating nursing diagnoses and clinical reasoning in all contexts of professional nursing care. Further discussion on the subject is also necessary, with the aim of validating the suggested nursing diagnoses, as well as their indicators, in more in-depth studies of experience reports and clinical cases.

Innovative Teaching Strategies Using Simulation for Pediatric Nursing Clinical Education During the Pandemic: A Case Study.

Existing challenges associated with pediatric clinical placements for prelicensure nursing students were heightened when clinical agencies halted nursing student entry in response to the COVID-19 pandemic. At the same time, the pandemic created opportunities for innovative teaching strategies for pediatric clinical rotations in nursing education. The purpose of this project was to design, develop, and implement meaningful, interactive, and intentional clinical experiences for nursing students that enhanced their pediatric assessment skills, reduced their anxiety about pediatric inpatient care, and advanced their proficiency in the nursing process. Two simulated clinical experiences were created: (1) a virtual pediatric physical assessment checkoff and (2) a pediatric escape room. The pediatric physical assessment checkoff was performed in a remote, virtual setting while students used personal resources to demonstrate their assessment skills. For the escape room, students worked in small, in-person groups using the nursing process to unlock clues to improve their client's health condition. Students reported gaining meaningful clinical experiences through simulation that allowed them to apply their nursing knowledge and increased their confidence in pediatric assessment skills, dosage calculation competency, communications and interactions with the pediatric population, and teamwork abilities. The virtual pediatric physical assessment checkoff and the pediatric escape room were enjoyable and beneficial educational events that facilitated student learning.

Identifying Frequently Used NANDA-I Nursing Diagnoses, NOC Outcomes, NIC Interventions, and NNN Linkages for Nursing Home Residents in Korea.

This study aimed to identify the terminologies of NANDA-I, NOC, NIC, and NNN linkages that have been used for nursing home (NH) residents. This study used a retrospective descriptive design. Data accrued from 57 registered nurses (RNs) in 25 Korean NHs. The RNs randomly selected one resident and assessed for applied NANDA-I, NOC, and NIC from the previous 7 days by reviewing nursing charts and records. Finally, the data of 57 residents in 25 NHs were collected. Results: We identified seven NNN linkages: risk for falls-fall prevention behavior-fall prevention; self-care deficit: bathing/hygiene-self-care: activities of daily living (ADL)-self-care assistance: bathing/hygiene; impaired memory-memory-cognitive stimulation; chronic confusion-neurological status: consciousness-medication management; chronic confusion-memory-medication management; impaired walking-mobility-exercise promotion: strength training; and impaired walking-ambulation-exercise promotion: strength training. The identified core NANDA-I, NOC, NIC, and NNN linkages for NH residents from this study provide a scope of practice of RNs working in NHs.

Implementing Holistic Care in Isolated Patients During COVID-19 Pandemic: A Case Study Using Nursing Outcomes (NOC) and Interventions (NIC) Classifications.

The most effective strategy against SARS-Cov-2 virus spread is therapeutic isolation. Consequences of this measure are the presence of anxiety and depression. Therefore, it is the nurse's responsibility to identify strategies to implement humanized and holistic care in order to avoid physical and mental consequences of isolation.

The Most Commonly Determined Nursing Diagnoses According to NANDA-I Taxonomy and Difficulties Using the Nursing Process in COVID-19 Outbreak.

The study was planned to determine the most common nursing diagnoses according to NANDA International (NANDA-I) taxonomy and difficulties experienced in using of nursing process in COVID-19 outbreak. The sample of the descriptive cross-sectional study consisted of nurses cared for patients with COVID-19 (n = 114). Average age of nurses is 26.86 ± 6.68. Commonly determined nursing diagnoses according to NANDA-I taxonomy in patients with COVID-19 were imbalanced nutrition (66.7%), impaired gas exchange (40.4%), insomnia (21.1%), acute confusion (31.6%), hopelessness (96.5%), difficulty playing caregiver (84.2%), anxiety (38.6%) willingness to strengthen religious bond (71.9%), risk for infection (64.9%), nausea (49.1%). Twenty-four-years old and younger, high school graduates, caring for intubated patients, and those who stated that they did not use nursing diagnosis had more difficulty in using nursing process (<0.05). The use of nursing diagnoses and process for patients with COVID-19 is extremely important in ensuring individual and qualified nursing care.

Religious practice in the pandemic of COVID-19 and the nursing diagnoses.

PURPOSE: Identify the elements (defining characteristics, related factors, and risk factors) of the diagnoses of NANDA international impaired religiosity (00169), risk for impaired religiosity (00170), and readiness for enhanced religiosity (00171), in a period of social distancing in the pandemic of COVID-19, and associate them with the behavior of individual and collective religious practice, before and during the pandemic. METHODS: Survey study, released via social media to members of religious communities in Brazil. Data collection took place in June 2020, by online questionnaire. FINDINGS: Participants were 719 people, 563 (78.3%) were women, with a median age of 39 years (min 18-max 73), of Catholic religion (64.7%), with a median of 29 years of religious practice (min 0-max 70). The participants were from Southeast 652 (90.68%), South 49 (6.82%), Northeast 13 (1.82%), Midwest 4 (0.56%), and North 01 (0.14%) of Brazil. The increase of individual religious practice was associated with two diagnostic elements and the reduction of individual practice to nine elements. The reduction of collective religious practice was associated with seven diagnostic elements and the maintenance of the practice associated with five elements. The increase of collective religious practice was associated with five diagnostic elements. CONCLUSIONS: In individuals who presented during the pandemic reduction of individual religious practice, reduction of collective religious practice, and maintenance of collective religious practice, the elements of the diagnosis impaired religiosity were predominant. In individuals who presented increased practice of collective religious activity during the pandemic, the elements of the diagnosis readiness for enhanced religiosity were predominant. IMPLICATIONS FOR NURSING PRACTICE: This study highlights defining characteristics, risk factors, and related factors of the religiosity diagnoses presented due to social distancing in the pandemic; these should be screened during nursing consultations in primary health care.

Perinatal depression screening: Improving outcomes during COVID-19.

ABSTRACT: Recommendations for social distancing and avoidance of mass gatherings during the COVID-19 pandemic have correlated with increased depressive symptoms in some individuals, such as loss of interest in daily activities, sleeplessness, or sadness. Perinatal depression screening using established, validated tools can aid with early diagnosis, guide management strategies, and optimize outcomes for pregnant women and their families. Identifying at-risk patients early in pregnancy and implementing a plan of care with appropriate mental health resources such as counseling or therapy have been shown to decrease clinical depression by more than 40%.

Multisystem inflammatory syndrome in children: A complication of COVID-19.

ABSTRACT: Multisystem inflammatory syndrome in children is a previously unrecognized and potentially catastrophic illness that appears in children who have been exposed to or diagnosed with COVID-19. As healthcare agents and members of the community, nurses are positioned to assist in identifying children who may experience previously unrecognized complications of infection from the SARS-CoV-2 virus.

Diagnostics of care about environment: A systematic review through nursing taxonomies.

AIM: To analyse the representation of the environment in nursing diagnostic taxonomies. DESIGN: Systematic scoping review through nursing taxonomies. METHODS: The first phase identified nursing diagnostic taxonomies by systematic review. The diagnoses were associated with the environment by analysis of terms into the diagnosis label and definition. Data analysis was quantitative with frequency measurements. The second phase mapped the identified diagnoses to establish equivalences using analysis by terms in the diagnostic labels. Finally, the findings obtained in the first phase were compared with the OMAHA System. RESULTS: The bibliographic search identified 112 studies and 16 standardized languages for diagnoses. NANDA-I and ICNP were the most frequent taxonomies; ATIC, the most recent; and OMAHA, the oldest. 2,062 diagnoses from four diagnostic taxonomies were analysed, and 361 associations corresponding to 352 environmental diagnoses were identified. All taxonomies included the environment but with different weight relative to the interpersonal and geopolitical category.

COVID-19 pneumonia: What APRNs should know.

ABSTRACT: COVID-19-associated pneumonia is a complex acute care diagnosis that requires careful evaluation and management. This article includes pertinent recommendations for management of acutely ill patients with COVID-19 pneumonia.

Validation of a manual of care plans for people hospitalized with COVID-19.

AIM: Validate a manual of care plans for people hospitalized for coronavirus disease, COVID-19. DESIGN: Validation study with a mixed-method design. METHODS: Design and validation of a care plans manual for people hospitalized by COVID-19. Care plans used standardized languages: NANDA-I, Nursing Outcomes Classification (NOC) and Nursing Intervention Classification (NIC). The design included external and internal validation with quantitative and qualitative analysis. Data collection was between March and June 2020. The study methods were compliant with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist. RESULTS: The manual integrated 24 NANDA-I diagnoses, 34 NOC and 47 NIC different criteria. It was validated by experts of Scientific-Technical Commission, who recommended linking the diagnoses to an assessment. The internal validation validated 17 of 24 diagnoses, 56 of 65 NOC and 86 of the 104 NIC. During the discussion group, 6 new diagnoses proposed were validated and the non-validated diagnoses were linked to the baseline condition of the person.

COVID-19-related smell and taste disorders: A guide for nurses.

ABSTRACT: Olfactory impairment is recognized as a hallmark of COVID-19. This article highlights dysfunction of smell and taste associated with COVID-19 and discusses implications for nursing practice.

NANDA-I, NOC, and NIC linkages to SARS-CoV-2 (COVID-19): Part 3. Family response.

PURPOSE: To provide guidance to nurses caring for families with COVID-19, we developed linkages using interoperable standardized nursing terminologies: NANDA International (NANDA-I) nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). In addition, we wanted to identify gaps in the terminologies and potential new nursing diagnoses, outcomes, and interventions for future development related to nurse roles in family care during a pandemic. METHODS: Using a consensus process, seven nurse experts created the linkages focused on families during the COVID-19 pandemic using the following steps: (1) creating an initial list of potential nursing diagnoses, (2) selecting and categorizing outcomes that aligned with all components of each nursing diagnosis selected, and (3) identifying relevant nursing interventions. FINDINGS: We identified a total of seven NANDA-I nursing diagnoses as the basis for the linkage work. These are distributed in three NANDA-I Domains and based in the psychosocial dimension of the Nursing Care in Response to Pandemics model. Eighty-nine different NOC outcomes were identified to guide care based on the nursing diagnoses, and 54 different NIC interventions were suggested as possible interventions. Fifteen new proposed concepts were identified for future development across the three classifications. CONCLUSIONS: The linkages of nursing diagnoses, outcomes, and interventions provide a guide to enhance nursing practice and care documentation that could quantify the impact of nursing care to patient outcomes for families at risk for or infected by COVID-19. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I, NOC, and NIC linkages identified in this paper provide resources to support clinical decisions and guide critical thinking for nurses encountering care needs of families with COVID-19. Documentation of these linkages provides data that can create new knowledge to enhance the care of families impacted by COVID-19.

Opportunities for the advanced practice nurse in improving the wellbeing of older adults during the COVID-19 pandemic.

The prevalence of stress, anxiety, and depression have increased during the coronavirus disease (COVID-19) pandemic across age groups. Older adults may additionally be experiencing accelerated cognitive decline and increased behavioral and psychological symptoms of dementia related to the pandemic and associated isolation precautions. The advanced practice nurse has an opportunity to holistically intervene to mitigate the negative effects of isolation and promote older adults' wellbeing during challenging times.

NANDA-I, NOC, and NIC linkages to SARS-CoV-2 (COVID-19): Part 2. Individual response.

PURPOSE: To provide guidance to nurses caring for individuals with COVID-19, we developed linkages using interoperable standardized nursing terminologies: NANDA International (NANDA-I) nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). We also identified potential new NANDA-I nursing diagnoses, NOC outcomes, and NIC interventions for future development related to nurses' role during a pandemic. METHODS: Using a consensus process, seven nurse experts created the linkages for individuals during the COVID 19 pandemic using the following steps: (a) creating an initial list of potential nursing diagnoses, (b) selecting and categorizing outcomes that aligned with all components of each nursing diagnosis selected, and (c) identifying relevant nursing interventions. FINDINGS: A total of 16 NANDA-I nursing diagnoses were identified as the foundation for the linkage work, organized in two dimensions, physiological and psychosocial. A total of 171 different NOC outcomes were identified to guide care based on the nursing diagnoses and 96 NIC interventions were identified as suggested interventions. A total of 13 proposed concepts were identified for potential future development across the three classifications. CONCLUSIONS: The linkages of nursing diagnoses, outcomes, and interventions developed in this article provide a guide to enhance nursing practice and determine the effectiveness of nurses' contribution to patient outcomes for individuals at risk for or infected by COVID-19. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I, NOC, and NIC linkages identified in this paper are an important example of the value of using standardized nursing terminologies to guide and document nursing care. When included in electronic health record databases and used widely, the data generated from the care plans can be used to create new knowledge about how to better improve outcomes for patients with COVID-19.

Brazilian Nursing Process Research Network contributions for assistance in the COVID-19 pandemic.

OBJECTIVE: to describe the theoretical construction process of nursing process support documents in COVID-19 care scenarios. METHODS: an experience report of the joint activity of the Brazilian Nursing Process Research Network (Rede de Pesquisa em Processo de Enfermagem) composed of Higher Education and Health Institution researchers in Brazil. RESULTS: five instruments were organized collectively, involving the elements of nursing practice (nursing diagnoses, outcomes and interventions) in assistance for community; for patients (with suspected or mild, moderate, and critical COVID-19 and residents in Nursing Homes); for nursing workers' health support, also subsidizing registration and documentation during the COVID-19 pandemic. FINAL CONSIDERATIONS: valuing the phenomena manifested by families/communities, patients and health professionals is essential for early detection, intervention, and prevention of diseases.