Participant action research with bedside nurses to identify NANDA-International, Nursing Interventions Classification, and Nursing Outcomes Classification categories for hospitalized persons with diabetes.

Experienced bedside nurses identified 14 nursing diagnoses, 78 interventions, and 76 health outcomes for hospitalized persons with diabetes. Using these terms, the nursing department revised the standards of care and the electronic health record. Nurses' engagement in generating knowledge translated to increased interest in research. This methodology is recommended for other agencies.

Supporting breast-feeding when a woman is homeless.

PURPOSE: This case study demonstrates use of standardized nursing languages in the care of new mothers in community settings. DATA SOURCES: The author collected data from clinical practice as an instructor in a baccalaureate nursing program and from the research literature. DATA SYNTHESIS: The appropriate nursing diagnoses, outcomes, and interventions were identified in partnership with the new mother. CONCLUSIONS: This case shows that NANDA International (NANDA-I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) are useful to direct nursing care in community settings. IMPLICATIONS FOR NURSING: When teaching nursing students in a baccalaureate program, nurse faculty can use NANDA-I, NOC, and NIC classifications to guide the growing practice of nursing students in community settings.

Consensus-validation study identifies relevant nursing diagnoses, nursing interventions, and health outcomes for people with traumatic brain injuries.

A consensus-validation study used action research methods to identify relevant nursing diagnoses, nursing interventions, and patient outcomes for a population of adults with traumatic brain injury (TBI) in long-term care. In meetings totaling 159 hours to reach 100% consensus through group discussions, the three classifications of NANDA International's (NANDA-I's) approved nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) were used as the basis for three nurses experienced in working with adults with TBI to select the elements of nursing care. Among almost 200 NANDA-I nursing diagnoses, 29 were identified as relevant for comprehensive nursing care of this population. Each nursing diagnosis was associated with 3-11 of the more than 500 NIC interventions and 1-13 of more than 300 NOC outcomes. The nurses became aware of the complexity and the need for critical thinking. The findings were used to refine the facility's nursing standards of care, which were to be combined with the interdisciplinary plan of care and included in future electronic health records.

Case study: child with global developmental delay.

PURPOSE: This case study focused on the care of a child with global developmental delay. DATA SOURCES: Data were obtained through the author's clinical practice in long-term care pediatric rehabilitation and literature sources. DATA SYNTHESIS: NANDA-International Classifications, the Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) were used to identify the appropriate nursing diagnosis, nursing interventions, and patient outcomes. CONCLUSIONS: This case study provides the pertinent nursing diagnoses, interventions, and outcomes for a child with global developmental delay. The interdisciplinary team approach and family involvement is addressed. IMPLICATIONS FOR NURSING: Use of NANDA, NIC, and NOC outcomes constructs for enhancing the care of a child with global developmental delay.

Use of critical thinking in the diagnostic process.

PURPOSE: To demonstrate use of critical thinking in the diagnostic process in order to achieve accuracy of nursing diagnoses. METHODS: The 7 cognitive skills and 10 habits of mind identified as important for nursing in a Delphi study by Scheffer and Rubenfeld are applied to the diagnostic process using a published case study of a woman with heart failure. FINDINGS: Taking into account all data from the case study and using the concepts of critical thinking, two high-accuracy nursing diagnoses were selected to guide nursing interventions. CONCLUSIONS: Because the specific types of critical thinking needed for accurate diagnosing are not known, nurses should develop all 17 of the cognitive skills and habits of mind so these thinking abilities are available when needed. PRACTICE IMPLICATIONS: The 17 critical thinking concepts should be combined with domain knowledge, e.g., nursing diagnoses, to think about thinking, which will improve critical thinking processes.

[Psychometric properties of Q-DIO, an instrument to measure the quality of documented nursing diagnoses, interventions and outcomes]. / Testtheoretische Gütekriterien des Q-DIO, eines Instruments zur Messung der Qualität der Dokumentation von Pflegediagnosen, -interventionen und -ergebnissen.

The instrument Q-DIO was developed in the years 2005 till 2006 to measure the quality of documented nursing diagnoses, interventions, and nursing sensitive patient outcomes. Testing psychometric properties of the Q-DIO (Quality of nursing Diagnoses, Interventions and Outcomes.) was the study aim. Instrument testing included internal consistency, test-retest reliability, interrater reliability, item analyses, and an assessment of the objectivity. To render variation in scores, a random strata sample of 60 nursing documentations was drawn. The strata represented 30 nursing documentations with and 30 without application of theory based, standardised nursing language. Internal consistency of the subscale nursing diagnoses as process showed Cronbach's Alpha 0.83 [0.78, 0.88]; nursing diagnoses as product 0.98 [0.94, 0.99]; nursing interventions 0.90 [0.85, 0.94]; and nursing-sensitive patient outcomes 0.99 [0.95, 0.99]. With Cohen's Kappa of 0.95, the intrarater reliability was good. The interrater reliability showed a Kappa of 0.94 [0.90, 0.96]. Item analyses confirmed the fulfilment of criteria for degree of difficulty and discriminative validity of the items. In this study, Q-DIO has shown to be a reliable instrument. It allows measuring the documented quality of nursing diagnoses, interventions and outcomes with and without implementation of theory based, standardised nursing languages. Studies for further testing of Q-DIO in other settings are recommended. The results implicitly support the use of nursing classifications such as NANDA, NIC and NOC.

Nurse anesthetist follow-up of an adolescent female with gunshot trauma: a case study.

PURPOSE. This case study was written to demonstrate the usefulness of standardized nursing diagnoses, outcomes, and interventions in nurse anesthetist care of an adolescent trauma patient. DATA SOURCES. Literature reviews using Academic Premier, Google Scholar, and CINAHL databases were done to find current, relevant articles concerning evaluation and support of female African-American adolescents living in socially vulnerable and economically exploited environments. DATA SYNTHESIS. A case is presented and evidence from current publications is analyzed to support the diagnosis, outcomes, and interventions. CONCLUSION. The investment in extra time, care, and effort sometimes required for the full development of a treatment plan for teenagers who live where they are at high risk for violence and other consequences of stressful environments is a worthwhile one, even if results may require contact over an extended time period. PRACTICE IMPLICATIONS. Nurses of all specialty backgrounds need to be concerned with the progress of their patients. Sometimes nurses can best serve their patients by stepping away from the physiological event and focusing instead on responses in the domain of coping and stress tolerance as the root of difficulties.

Standardized nursing languages: essential for the nursing workforce.

The evolution of standardized nursing languages (SNLs) has been occurring for more than four decades. The importance of this work continues to be acknowledged as an effective strategy to delineate professional nursing practice. In today's health care environment, the demand to deliver cost-effective, safe, quality patient care is an essential mandate embedded in all health reform policies. Communicating the contributions of professional nursing practice to other nurses, health providers, and other members of the health care team requires the articulation of nursing's focus of concern and responses to these concerns to improve patient outcomes. The visibility of the electronic health record (EHR) in practice settings has accelerated the need for nursing to communicate its practice within the structure of the electronic format. The integration of SNLs into the patient record offers nurses an opportunity to describe the focus of their practice through the identification of nursing diagnosis, interventions and outcomes (IOM, 2010). Continued development, testing, and refinement of SNLs offers nursing an accurate and reliable way to use data elements across populations and settings to communicate nursing practice, enable nursing administrators and leaders in health care to delineate needed resources, cost out nursing care with greater precision, and design new models of care that reflect nurse-patient ratios and patient acuity that are data driven (Pesut & Herman, 1998). The continued use of nursing languages and acceleration of nursing research using this data can provide the needed evidence to help link nursing knowledge to evidence-driven, cost-effective, quality outcomes that more accurately reflect nursing's impact on patient care as well as the health care system of which they are a part. The evaluation of research to support the development, use, and continued refinement of nursing language is critical to research and the transformation of patient care by nurses on a global level.

Helping a man with leprosy: a case study.

PURPOSE: This case study illustrates nursing diagnoses and interventions for a man with leprosy. DATA SOURCES: Data sources were published literature on the disease of leprosy, and the experience and expertise of the authors in working with people with leprosy. DATA SYNTHESIS: Data were synthesized using the standardized nursing languages of North American Nursing Diagnosis Association International 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: Although leprosy has been eradicated in some countries, the risk of new cases is present anywhere that Mycobacterium leprae still exists. The recommended treatment of multibacilar polychemotherapy has lowered the rate of new cases in Brazil. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to incorporate evidence-based practice interventions for leprosy-based wound care, and nurses should encourage persons with leprosy to maintain regular medical care with multibacilar polychemotherapy.

Improving critical thinking and clinical reasoning with a continuing education course.

BACKGROUND: Continuing education courses related to critical thinking and clinical reasoning are needed to improve the accuracy of diagnosis. METHOD: This study evaluated a 4-day, 16-hour continuing education course conducted in Brazil.Thirty-nine nurses completed a pretest and a posttest consisting of two written case studies designed to measure the accuracy of nurses' diagnoses. RESULTS: There were significant differences in accuracy from pretest to posttest for case 1 (p = .008) and case 2 (p = .042) and overall (p = .001). CONCLUSION: Continuing education courses should be implemented to improve the accuracy of nurses' diagnoses.

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

AIMS AND OBJECTIVES: This paper aims to report the development stages of an audit instrument to assess standardised nursing language. Because research-based instruments were not available, the instrument Quality of documentation of nursing Diagnoses, Interventions and Outcomes (Q-DIO) was developed. BACKGROUND: Standardised nursing language such as nursing diagnoses, interventions and outcomes are being implemented worldwide and will be crucial for the electronic health record. The literature showed a lack of audit instruments to assess the quality of standardised nursing language in nursing documentation. DESIGN: A qualitative design was used for instrument development. METHODS: Criteria were first derived from a theoretical framework and literature reviews. Second, the criteria were operationalized into items and eight experts assessed face and content validity of the Q-DIO. RESULTS: Criteria were developed and operationalized into 29 items. For each item, a three or five point scale was applied. The experts supported content validity and showed 88.25% agreement for the scores assigned to the 29 items of the Q-DIO. CONCLUSIONS: The Q-DIO provides a literature-based audit instrument for nursing documentation. The strength of Q-DIO is its ability to measure the quality of nursing diagnoses and related interventions and nursing-sensitive patient outcomes. Further testing of Q-DIO is recommended. RELEVANCE TO CLINICAL PRACTICE: Based on the results of this study, the Q-DIO provides an audit instrument to be used in clinical practice. Its criteria can set the stage for the electronic nursing documentation in electronic health records.

Scoring rubric for grading students' participation in online discussions.

Required discussions of course readings provide motivation for students to learn course content and can be used to validate students' comprehension of course content and processes. A tool for grading the students' weekly discussions of course work was tested to evaluate the interrater reliability of grading by two faculty members. The purpose of this article is to describe psychometric testing of the interrater reliability of this grading method. Using the grading tool, independent ratings of five students' online discussion postings were recorded by both faculty members over a 5-week period, which provided the data for this study. Data were analyzed using Spearman rho and Kendall tau-b statistics. The findings revealed that the overall correlations of rater scores were satisfactory and indicated that an acceptable level of interrater reliability was obtained through use of the grading tool. Reliable tools for evaluation of students' online discussions contribute to the knowledge needed for the implementation of online courses.

[Quality of nursing diagnoses, interventions and outcomes: criteria and operationalization of the measurement instrument Q-DIO]. / Qualität von Pflegediagnosen, -interventionen und -ergebnissen: Kriterien und Operationalisierung des Messinstruments Q-DIO.

Financial, legal and professional demands require the nursing profession to render its contribution to patient care transparent. Due to the lack of research-based tools, the instrument Quality of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) was developed. The aims of this article are to describe the criteria and the operationalisation of an instrument to measure the quality of documented nursing diagnoses, nursing interventions, and nursing outcomes; and to present the instrument. The criteria for the instrument were developed on the basis of a theoretical framework and systematic literature reviews and operationalised into items. Eight experts were involved in face validity and content validity testing. Preliminary testing of inter-rater reliability was also conducted. Development of this instrument results in operationalisation and findings of pretesting. Literature-based criteria were developed into 29 items. All items utilise a scale of 3 to 5 points. The experts corroborated content validity and inter-rater agreement of 88.25% on the 29 items. The measurement instrument Q-DIO provides the result of this study. The strength of the Q-DIO lies in its capacity to measure the quality of documented nursing diagnoses in conjunction with corresponding interventions and nursing-sensitive outcomes. Further testing of the validity and reliability of the Q-DIO is recommended.

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.

The need for international nursing diagnosis research and a theoretical framework.

PURPOSE: To describe the need for nursing diagnosis research and a theoretical framework for such research. DATA SOURCES: A linguistics theory served as the foundation for the theoretical framework. DATA SYNTHESIS: Reasons for additional nursing diagnosis research are: (a) file names are needed for implementation of electronic health records, (b) international consensus is needed for an international classification, and (c) continuous changes occur in clinical practice. A theoretical framework used by the author is explained. CONCLUSIONS: Theoretical frameworks provide support for nursing diagnosis research. Linguistics theory served as an appropriate exemplar theory to support nursing research. IMPLICATION: Additional nursing diagnosis studies based upon a theoretical framework are needed and linguistics theory can provide an appropriate structure for this research.

Current knowledge related to intelligence and thinking with implications for the development and use of case studies.

PURPOSE: This paper reviews current knowledge regarding intelligence and thinking, and relates this knowledge to learning to diagnose human responses and to select health outcomes and nursing interventions. DATA SOURCES: Knowledge from relevant literature sources was summarized. DATA SYNTHESIS: The provision of high-quality nursing care requires use of critical thinking with three elements of nursing care: nursing diagnosis, health outcomes, and nursing interventions. Metacognition (thinking about thinking) should be used with knowledge of the subject matter and repeated practice in using the knowledge. Because there are limited clinical opportunities to practice using metacognition and knowledge of these nursing care elements, case studies can be used to foster nurses' expertise. CONCLUSIONS: Simulations of clinical cases are needed that illustrate application of the nursing knowledge represented in NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification. IMPLICATIONS: The International Journal of Nursing Terminologies and Classifications will promote the dispersion of case studies as a means of facilitating the implementation and use of nursing languages and classifications.

Tool development for evaluation of clinical nurse specialist competencies in graduate students: a pilot study.

PURPOSE: The purpose of this study was psychometric testing of the tool, Self Evaluation of CNS Competency Development. METHODS: The tool was developed using the NACNS competencies, with some concepts added to reflect graduate program objectives. The student sample was 33 students who provided informed consent and completed the tool. The preceptor sample was 6 preceptors who clinically supervised 6 students. RESULTS: As expected, independent samples t tests with matched pairs of 6 students and preceptors showed that there were no mean differences in 9 of the 12 categories within the 3 spheres of influence. Using the contrasted groups approach, discriminant function analysis showed that 91.7% of beginning and ending students were correctly classified. Cronbach alpha was estimated as .96. CONCLUSION: Results show partial support for criterion-related validity and construct validity. Tool reliability is satisfactory. Further testing with larger samples of students and clinical nurse specialists is recommended.

Stress overload: a new diagnosis.

PURPOSE: To describe the phenomenon of stress overload as a nursing diagnosis. METHODS: A qualitative study using case study method was conducted with nine adults experiencing stress overload to fully describe the experience and identify possible defining characteristics. Current literature sources on stress and its related factors were examined to support stress overload as a nursing diagnosis for inclusion in the NANDA International classification. FINDINGS: Stress overload, defined as excessive amounts and types of demands that require action, is a human response that is experienced as a problem and contributes to the development of other problems. The proposed defining characteristics are perceives situational stress as excessive, expresses a feeling of tension or pressure, expresses difficulty in functioning as usual, expresses problems with decision-making, demonstrates increased feelings of anger and impatience, and reports negative effects from stress such as physical symptoms or psychological distress. PRACTICE IMPLICATIONS: Nursing interventions such as active listening and decision-making support are needed to help people reduce stress levels. Studies are needed to further validate the defining characteristics and related factors of this new diagnosis.