The transcultural adaptation and the validity and reliability of the Turkish Version of Perroca's Patient Classification Instrument.

AIM: This study examines the transcultural adaptation and the reliability and validity of the Turkish version of Perroca's Patient Classification Instrument. BACKGROUND: Nurse managers need valid and reliable patient classification tools for determining patients' acuity or dependency levels on nursing care for measuring nursing workloads. METHODS: This study was conducted in two stages in a private hospital in Istanbul, Turkey. First, the instrument was translated, and its content validation was analysed. In the second stage, data were gathered from 300 hospitalized patients and were analysed by factor analyses, Cronbach's alpha and Cohen's kappa. RESULTS: Validity testing with ten experts revealed a scale-content validity index of 0.93. Exploratory factor analysis revealed a two-dimensional instrument with distinct factor loadings and a variance of 66.97%. The confirmatory factor analysis revealed that the fit indices were satisfactory. This instrument had an overall Cronbach's alpha coefficient of .86 and Cohen's kappa coefficient of .826. CONCLUSION: The study provides evidence that the Turkish version of Perroca's Patient Classification Instrument is a valid and reliable tool to determine patients' acuity levels on nursing care. IMPLICATIONS FOR NURSING MANAGEMENT: This instrument may be used by nurse managers to determine acuity levels of patients and measure nursing workload.

Validation of the Registered Nurse Assessment of Readiness for Hospital Discharge Scale.

BACKGROUND: Statistical models for predicting readmissions have been published for high-risk patient populations but typically focus on patient characteristics; nurse judgment is rarely considered in a formalized way to supplement prediction models. OBJECTIVES: The purpose of this study was to determine psychometric properties of long and short forms of the Registered Nurse Readiness for Hospital Discharge Scale (RN-RHDS), including reliability, factor structure, and predictive validity. METHODS: Data were aggregated from two studies conducted at four hospitals in the Midwestern United States. The RN-RHDS was completed within 4 hours before hospital discharge by the discharging nurse. Data on readmissions and emergency department visits within 30 days were extracted from electronic medical records. RESULTS: The RN-RHDS, both long and short forms, demonstrate acceptable reliability (Cronbach's alphas of .90 and .73, respectively). Confirmatory factor analysis demonstrated less than adequate fit with the same four-factor structure observed in the patient version. Exploratory factor analysis identified three factors, explaining 60.2% of the variance. When nurses rate patients as less ready to go home (<7 out of 10), patients are 6.4-9.3 times more likely to return to the hospital within 30 days, in adjusted models. DISCUSSION: The RN-RHDS, long and short forms, can be used to identify medical-surgical patients at risk for potential unplanned return to hospital within 30 days, allowing nurses to use their clinical judgment to implement interventions prior to discharge. Use of the RN-RHDS could enhance current readmission risk prediction models.

Instrumento instrucional do resultado NOC: conhecimento controle da doença cardíaca para portadores de insuficiência cardíaca / Instructional instrument of the NOC outcomes: control knowledge of cardiac disease for patients with heart failure

A insuficiência cardíaca (IC) é uma doença que apresenta altos índices de re-hospitalizações, ocasionadas em algumas situações pelo conhecimento deficiente dos portadores quanto ao controle e autogestão desta doença. Esse trabalho teve como objetivo elaborar e validar o conteúdo de um instrumento instrucional de avaliação dos indicadores do resultado NOC Conhecimento da Doença Cardíaca para pacientes com insuficiência cardíaca. Foi realizado a validação de conteúdo pela análise de seis experts na área de Cardiologia, sendo avaliado a concordância dos mesmos pelo teste de Kappa. Obteve-se o nível de concordância Kappa superior a 98% em todos os critérios avaliados, portanto foi considerado o instrumento como validado no conteúdo. Este estudo é fundamental para a prática clínica dos enfermeiros, pois poderá nortear a avaliação do enfermeiro no conhecimento do paciente com IC.

Heart failure (HF) is a disease that presents high levels of re-hospitalizations, in some situations caused by deficient knowledge of patients regarding the control and self-management of the disease. This study aimed to elaborate and validate the content of an instructional instrument to assess the indicators of the NOC outcome Cardiac Disease Knowledge for patients with heart failure. A content validation was conducted by the analysis of six cardiology experts, and the agreement between them was assessed by the Kappa statistic. The obtained Kappa agreement level was superior to 98% for all assessed criteria, therefore the instrument was considered valid for content. This study is fundamental for the clinical practice of nurses, as it can guide the nursing assessment for knowledge of patients with HF.

Fiabilidad de la etiqueta de clasificación de resultados de Enfermería «Conocimiento: control de la enfermedad cardiaca (1830)» en pacientes ambulatorios con insuficiencia cardiaca / Reliability of nursing outcomes classification label «Knowledge: cardiac disease management (1830)» in outpatients with heart failure

OBJETIVO: Determinar la fiabilidad (consistencia interna, reproducibilidad interevaluador y nivel de acuerdo) del resultado de enfermería: «Conocimiento: control de la enfermedad cardiaca (1830)» de la versión publicada en español, en pacientes ambulatorios con insuficiencia cardiaca. MÉTODOS: Estudio de fiabilidad realizado en 116 pacientes ambulatorios con insuficiencia cardiaca. Se operacionalizaron seis indicadores del resultado de enfermería. Todos los participantes fueron valorados simultáneamente por dos evaluadores. Se definieron tres periodos de evaluación: inicial (al comienzo del estudio), final (al mes) y seguimiento (a los dos meses). Análisis estadístico: consistencia interna mediante el coeficiente alpha de Cronbach, reproducibilidad interevaluador con el coeficiente de correlación intraclase de reproducibilidad o acuerdo y nivel de acuerdo a través de los límites de acuerdo del 95% de Bland y Altman. RESULTADOS: El alpha de Cronbach fue de 0,83 IC 95% (0,77; 0,89) en la evaluación final y para el seguimiento se encontraron valores de 0,85 IC 95% (0,82; 0,89) y 0,83 IC 95% (0,78; 0,88), para el primer y segundo evaluador, respectivamente. El coeficiente de correlación intraclase presentó valores mayores a 0,9 en los tres momentos de evaluación tanto en el modelo aleatorio como en el mixto. Los límites de acuerdo del 95% de Bland y Altman fueron cercanos a cero en las tres evaluaciones realizadas. CONCLUSIONES: El cuestionario operacionalizado para valorar el resultado de enfermería: «Conocimiento: control de la enfermedad cardiaca (1830)» en su versión en español, es un método confiable para medir habilidades y conocimientos en pacientes ambulatorios con insuficiencia cardiaca en el contexto colombiano

OBJECTIVE: To determine the reliability (internal consistency, inter-rater reproducibility and level of agreement) of nursing outcome: 'Knowledge: cardiac disease management (1830)' of the version published in Spanish, in outpatients with heart failure. METHODS: A reliability study was conducted on 116 outpatients with heart failure. Six indicators of nursing outcome were operationalized. All participants were assessed simultaneously by two evaluators. Three evaluation periods were defined: initial (at baseline), final (a month later), and follow-up (two months later). Statistical analysis: Internal consistency by Cronbach alpha coefficient, inter-rater reproducibility with intraclass correlation coefficient of reproducibility or agreement and level agreement using the 95% limits of Bland and Altman. RESULTS: Cronbach's alpha was 0.83 (95% CI: 0.77 - 0.89) in the final evaluation, and follow-up values of 0.85 (95% CI: 0.82-0.89) and 0.83 (95% CI: 0.78 - 0.88) were found for the first and second evaluator, respectively. The intraclass correlation coefficient showed values greater 0.9 in the three evaluation periods in both the random and mixed model. The Bland-Altman 95% limits of agreement were close to zero in the three evaluations performed. CONCLUSIONS: The questionnaire operationalized to assess the nursing outcome: 'Knowledge: cardiac disease management (1830)' in its Spanish version, is a reliable method to measure skills and knowledge in outpatients with heart failure in the Colombian context

Tradução e adaptação transcultural do "Jones Dependency Tool" para o português brasileiro / Translation and cultural adaptation of the Jones Dependency Tool to Brazilian Portuguese / Traducción y adaptación transcultural del "Jones Dependency Tool" al portugués brasileño

Estudo metodológico com objetivo de traduzir para o português e realizar adaptação transcultural do Jones Dependency Tool. Método de tradução e adaptação transcultural utilizado composto por quatro fases. Primeira: tradução do instrumento original, em inglês, para português. Segunda: busca de equivalência de conteúdo, cultural, semântica e conceitual em relação ao instrumento original. Terceira: realização deretrotradução. Quarta: as versões, traduzida e retrotraduzida, foram comparadas por comitê de especialistas, resultando na versão final do instrumento. No Domínio Comunicação, a mensuração da dor no JDT original era descrita como faixa alta, intermediária e menor, o Comitê de Especialistas sugeriu a substituição pela escala analógica visual. A tradução e adaptação cultural da JDT para a língua portuguesa originou um instrumento aplicável à nossa realidade. Faz-se necessária a realização de estudos para testar a validade e confiabilidade da EDJ nos Serviços de Emergência no Brasil.

Methodological study to translate and culturally adapt the Jones Dependency Tool (JDT) to Portuguese. The translation and cultural adaptation method had four stages. First stage: translation of the original instrument from English to Portuguese. Second stage: content, cultural, semantic and conceptual equivalence in relation to the original instrument. Third stage: back-translation. Fourth stage: comparison of the translated and back-translated versions by a committee of specialists, resulting in the final version. In the Communication Domain, the original JDT measured pain using high, intermediate and low ranges, but the committee suggested replacing it with a visual analog scale. The translation and cultural adaptation of the JDT to Portuguese produced an instrument applicable to our reality. Studies need to be conducted to test the validity and reliability of the JDT in Brazilian Emergency Services.

Estudio metodológico que objetivó traducir al portugués y adaptar transculturalmente el Jones Dependency Tool. Traducción y adaptación transcultural dividida en cuatro fases. La primera fue la traducción del instrumento original, del inglés al portugués. La segunda fase buscó la equivalencia de contenido, cultural, semántica y conceptual en relación al instrumento original. La tercera fase fue de retrotraducción. La cuarta fase hizo comparar a una comisión de especialistas las versiones traducida y retrotraducida, dando lugar a la versión final del instrumento. En el Dominio Comunicación, la medición del dolor en el JDT original se describía en fajas: alto, medio y bajo. La Comisión de Especialistas sugirió la substitución por la escala visual. La traducción y adaptación cultural del JDT al portugués generó un instrumento aplicable a nuestra realidad. Será necesario realizar estudios para probar la validez y confiabilidad de la EDJ en los Servicios de Emergencias de Brasil.

Challenges associated with the secondary use of nursing data.

There is a prevailing 'collect once, use many times' view of clinical data and its secondary use. This study challenges this view through an assessment of the degree to which the International Classification for Nursing Practice (ICNP) might be used to provide raw data for the Belgian Nursing Minimum Data Set (B-NMDS). A mapping exercise identified exact matches between ICNP and B-NMDS for just 8% of B-NMDS care descriptions; no matches at all for 23%; possible broader matches in ICNP for 55%; possible narrower matches for 8%; and a possible broader and narrower match for 1%. Refining ICNP content and developing and implementing purposive data sets or catalogues that accommodate both ICNP concepts and B-NMDS care descriptions would lay the foundations for the potential re-use of primary ICNP-encoded data in populating the B-NMDS. One unexpected result of the study was to re-affirm the utility of ICNP as a reference terminology.

DPC in acute-phase inpatient hospital care. Visualization of amount of nursing care provided and accessibility to nursing care.

OBJECTIVE: The purpose of this study was to improve accessibility to nursing care by clarifying the relationship between patient characteristics and the amount of nursing care for the Diagnosis Procedure Combination system (DPC). METHOD: The subjects included 528 lung cancer patients; 170 gastric cancer patients; and 91 colon cancer patients, who were hospitalized from July 1, 2008, to March 31, 2010, at a university hospital. The patients were categorized into groups according to factors that could affect the amount of nursing care. Next, the relationship between the patient characteristics and the amount of nursing care was analyzed. Then the results from this study were used to classify patient characteristics according to the patient type and the amount nursing care required. RESULTS: The patient characteristics, which affected the amount of nursing care, varied according to each DPC code. The major factors affecting the amount of nursing care were whether the patient had received a surgical (under general anesthetics) treatment or a non-surgical treatment and the level of activities of daily living (ADL) of the hospitalized patients. For those who had received a surgical operation for colon cancer, the patient's age also affected the amount of nursing care. CONCLUSIONS: The findings show that the method for the visualization of the amount of nursing care based on the classification of patient characteristics can be implemented into the electronic health record system. This method can then be used as a management tool to assure appropriate distribution of nursing resources.

Standardized mapping of nursing assessments across 59 U.S. military treatment facilities.

OBJECTIVE: Create an interoperable set of nursing flowsheet assessment measures within military treatment facility electronic health records using the 3M Healthcare Data Dictionary (HDD). DESIGN: The project comprised three phases: 1) discovery included an in-depth analysis of the Essentris data to be mapped in the HDD; 2) mapping encompassed the creation of standard operating procedures, mapping heuristics, and the development of mapping tools; and 3) quality assurance incorporated validation of mappings using inter-rater agreement. RESULTS: Of 569,073 flowsheet concepts, 92% were mapped to the HDD. Of these, 31.5% represented LOINC concepts, 15% represented SNOMED CT and 1% represented both. 52.5% were mapped to HDD concepts with no standardized terminology representations. CONCLUSIONS: Nursing flowsheet data can be mapped to standard terminologies but there is not the breadth of coverage necessary to represent nursing assessments. Future work is necessary to develop a standard information model for the nursing process.

A case study of teen parenting.

PURPOSE: The purpose of this case study is to demonstrate how the use of the standard nursing languages of NANDA International (NANDA-I), the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) help a teen mother provide safe care for her newborn. In addition, this study aims to demonstrate how important standardized nursing languages are in documenting the care provided. DATA SOURCES: The data sources for this article are clinical nursing practice, research evidence in the form of care directives from the American Academy of Pediatrics regarding newborn safety and feeding, and the books that provide directions for the use of NANDA-I, NIC, and NOC. DATA SYNTHESIS: This case demonstrates the use of the nursing process in providing care for a teen mother and a newborn. CONCLUSIONS: Many new mothers, especially teens, are poorly informed regarding normal newborn care and safety upon hospital discharge. For this reason, teen mothers should be referred for nursing assessments in the home environment after discharge. IMPLICATIONS FOR NURSING: This case demonstrates the need for education of all parents prior to hospital discharge and supports the need for home-based evaluations to ensure the safety of the infant. This case also supports the use of standardized nursing language to document the care provided.

Assessment of comatose patients: a Portuguese instrument based on the Coma Recovery Scale - revised and using nursing standard terminology.

AIMS: To translate and adapt the Coma Recovery Scale - Revised to Portuguese using the ICNP® (International Classification of Nursing Practice) terminology and to determine if it can be administered reliably across examiners. BACKGROUND: Assessment tools for the person in a coma can contribute to the planning, implementation and evaluation of care. It also strengthens the autonomy and responsibility of nurses, contributing to the safety, quality and satisfaction of those who deliver and receive care. This allows the sharing of information amongst healthcare professionals and supports decision-making within a multidisciplinary team. METHODS: A convenience sample of 20 patients admitted to an intensive care unit constituted the study participants. The data were collected during 2009. The instrument was administered by the same two raters in all the patients on two consecutive days. The total and subscale score agreement was then examined, using inter-rater and test-retest analyses. The intercorrelation dependencies between the subscales were also analysed. RESULTS: The results of the analyses suggest that the instrument can be used reliably, even when there are some patient fluctuations. The correlation of the subscale scores was high and better than the results presented for the original Coma Recovery Scale - Revised, indicating that this scale is a homogeneous measure of neurobehavioural function. CONCLUSION: The new instrument can be administered reliably by trained examiners and produces a high degree of reproducibility in scores between raters over repeated assessments. We believe that assessment tools that can assess the communication ability of patients will be relevant to evaluating the continuity of care, and promote the effectiveness of care.

[The electronic use of the NANDA-, NOC- and NIC- classifications and implications for nursing practice]. / Die elektronische Anwendung der NANDA-, NOC- und NIC-Klassifikationen und Folgerungen für die Pflegepraxis.

The data model developed on behalf of the Nursing Service Commission of the Canton of Zurich (Pflegedienstkommission des Kantons Zürich) is based on the NANDA nursing diagnoses, the Nursing Outcome Classification, and the Nursing Intervention Classification (NNN Classifications). It also includes integrated functions for cost-centered accounting, service recording, and the Swiss Nursing Minimum Data Set. The data model uses the NNN classifications to map a possible form of the nursing process in the electronic patient health record, where the nurse can choose nursing diagnoses, outcomes, and interventions relevant to the patient situation. The nurses' choice is guided both by the different classifications and their linkages, and the use of specific text components pre-defined for each classification and accessible through the respective linkages. This article describes the developed data model and illustrates its clinical application in a specific patient's situation. Preparatory work required for the implementation of NNN classifications in practical nursing such as content filtering and the creation of linkages between the NNN classifications are described. Against the background of documentation of the nursing process based on the DAPEP(1) data model, possible changes and requirements are deduced. The article provides a contribution to the discussion of a change in documentation of the nursing process by implementing nursing classifications in electronic patient records.

Congruence between nursing problems in nursing care plans and NANDA nursing diagnoses.

This study abstracted nursing problems documented in cancer patients' nursing care plans to analyze (1) which nursing problems were documented and (2) the degree of congruence between the abstracted problems and NANDA nursing diagnoses. 236 unique nursing problems were identified and could be mapped to 32 NANDA nursing diagnoses. However, only 4.3% had a precise match with NANDA, Thirty-eight percent were classified as similar and the rest were broader, narrower or no match. Thus NANDA only partially covered problems written by nurses in the care plans for this group of patients.

The adequacy of ICNP version 1.0 as a representational model for electronic nursing assessment documentation.

OBJECTIVES: The purpose of this study was to evaluate the adequacy of the International Classification of Nursing Practice (1) (ICPN) Version 1.0 as a representational model for nursing assessment documentation. DESIGN AND MEASUREMENTS: To identify representational requirements of nursing assessments, the authors mapped key concepts and semantic relations extracted from standardized and local nursing admission assessment documentation forms/templates and inpatient admission assessment records to the ICNP. Next, they expanded the list of ICNP semantic relations with those obtained from the admission assessment forms/templates. The expanded ICNP semantic relations were then validated against the semantic relations identified from an additional set of admission assessment records and a set of 300 randomly selected North American Nursing Diagnosis Association defining characteristic phrases. The concept coverage of the ICNP was evaluated by mapping the concepts extracted from these sources to the ICNP concepts. The UMLS Methathesaurus was then used to map concepts without exact matches to other American Nursing Association (ANA) recognized terminologies. RESULTS: The authors found that along with the 30 existing ICNP semantic relations, an additional 17 are required for the ICNP to function as a representational model for nursing assessment documentation. Eight hundred and five unique assessment concepts were extracted from all sources. Forty-three percent of these unique assessment concepts had exact matches in the ICNP. An additional 20% had matches in the ICNP classified as narrower, broader, or "other." Of the concepts without exact matches in the ICNP, 81% had exact matches found in other ANA recognized terminologies. CONCLUSIONS: The broad concept coverage and the logic-based structure of the ICNP make it a flexible and robust standard. The ICNP provides a framework from which to capture and reuse atomic level data to facilitate evidence-based practice.

Acurácia de enfermeiros na classificação de risco em Unidade de Pronto Socorro de um Hospital Municipal de Belo Horizonte / Emergency medical services

A demanda de atendimento nos serviços de urgência tem aumentado consideravelmente nos últimos anos. Como estratégia de organização e humanização da assistência tem-se implantado o Acolhimento com Classificação de risco. Estratégias deacolhimento com protocolos para a classificação de risco têm sido implantadas nos serviçosde urgência e no Brasil. Estas têm incluído protocolos para garantir que critérios padronizados de avaliação dos usuários sejam implementados. Este estudo teve como finalidade investigar a acurácia dos enfermeiros na avaliação e classificação de risco estabelecidas no protocolo institucional de um hospital municipal de Belo Horizonte, Minas Gerais, pela avaliação dos registros dos Boletins de Entrada (BE); das divergências contidas na avaliação realizada pelos enfermeiros no que se refere à coleta das informações e estabelecimento das prioridades de atendimento; na avaliação da classificação de risco frente à presença, ausência e/ou alteraçãonos dados vitais e pela determinação da acurácia dos enfermeiros no estabelecimento dosníveis de classificação de risco, pela concordância entre eles e o protocolo institucional. Trata-se de estudo de coorte retrospectivo, com análise de registros de 382 fichas de atendimento dos usuários atendidos no setor de avaliação e classificação de risco, desde a implantação daestratégia de acolhimento em 22 de setembro de 2005 até 22 de setem...bro de 2007. Realizou-se uma análise descritiva com estabelecimento de freqüência simples e percentual, assim como índices de concordância para a determinação da acurácia dos enfermeiros classificadores com relação à classificação atribuída. Para isso, foram calculadas a sensibilidade, a especificidade, o Valor Preditivo Positivo (VPP), o Valor Preditivo Negativo(VPN) e o coeficiente Kappa para cada nível de classificação. Considerando que os registros são fundamentais para a atribuição do grau de risco ao usuário os resultados apontam uma...

Representing nursing assessment documentation with ICNP.

The purpose of this study was to identify key concepts and semantic relations necessary to represent standardized and local patient assessment items in an electronic documentation system and to evaluate the degree to which coverage of both are represented by ICNP. A total of 805 unique assessment concepts were identified. Forty-three percent had exact matches in ICNP, and an additional 20% had matches in the ICNP classified as narrower, broader or other.

Utilização de sistema de classificação de pacientes e métodosde dimensionamento de pessoal de enfermagem / The use of patient classification system and methods for nursing staff

O Sistema de Classificação de Pacientes (SCP) é uma forma de categorização do paciente de acordo com oseu grau de dependência em relação à assistência de enfermagem. Este estudo descritivo exploratório tem como objetivo investigar a utilização de SCP e dos métodos de dimensionamento de pessoal de enfermagemem instituições hospitalares. Participaram do estudo 50 enfermeiros clínicos e supervisores que atuam em Unidades de Clínica Médica, Cirúrgica e Especializada de duas instituições hospitalares (uma pública e umade ensino). Foi utilizado como instrumento de coleta de dados um questionário com questões semi-estruturadasaplicado nos meses de julho e agosto de 2006. Os resultados revelaram que os enfermeiros não estão utilizando o SCP e também que o dimensionamento de pessoal não tem sido fundamentado nos métodos preconizados na literatura. Dessa forma, torna-se fundamental para os enfermeiros a incorporação de conhecimentos científicos atualizados para instrumentalizar sua prática clínica.

The Patient Classification System (PCS) is a procedure to classify the patients according to their level ofdependence on nursing care. This descriptive, exploratory study aims at investigating the use of PCS andmethods for nursing staff dimensioning in medical institutions. Fifty clinical nurses and nurse managersworking in Clinical, Surgical and Specialized facilities of a public and a teaching hospital were enrolled in thestudy. Data were collected by means of a semi-structured questionnaire applied in July and August 2006.The results showed that the nurses do not use PCS and also that the nursing staff dimensioning has notbeen based on the methods recommended in the literature. Therefore, the nurses’ clinical practice must bebased on updated scientific knowledge.

Representing nursing assessment data with the ICNP.

Patient assessment provides the basis for identifying patient problems sensitive to nursing care and aligning nursing interventions to promote positive patient outcomes. We mapped the key concepts and attribute relations extracted from a set of initial patient assessment items to the International Classification for Nursing Practice (ICNP). Although we found the coverage of the ICNP not yet complete, we believe that the ICNP does have the potential to represent the nursing assessment data.