Men's health care: construction and validation of a tool for nursing consultation.

OBJECTIVES: to elaborate and validate a data collection tool for nursing consultation with men in the context of Primary Health Care. METHOD: a methodological study developed in four stages. The first one consisted in tool elaboration, using databases and the Dorothea Orem's theoretical model. In the second and third stages, content validation and tool appearance by 23 nurse judges took place. The Concordance Index was used for assessment. In the fourth stage, a pilot test was carried out with 20 men using Primary Health Care. RESULTS: of the 145 indicators prepared, organized and submitted to validation process, items with the Concordance Index <0.80 were excluded. The final tool consisted of 156 items. An overall 0.88 Concordance Index calculation was obtained. CONCLUSIONS: the final tool presented content validity for data collection with men in Primary Health Care.

Categorisation of goals set using Goal Attainment Scaling for treatment of leg spasticity: a multicentre analysis.

Background: Goal-classification of person-centred goals, using Goal Attainment Scaling for leg spasticity treatment. Methods: The study was conducted in two phases: phase I, a retrospective review to evaluate categories of goal set in routine clinical practice. Findings were used to design a goal classification system. Phase II, a multi-centre study to confirm the goal categories. Goals set (n = 270) were analysed from data collected at three centres in the UK (one centre for phase I). Goal categories were mapped onto the domains of the World Health Organisation, International Classification of Functioning Disability and Health. Results: One hundred and twenty seven participants were recruited in two cohorts: phase I: 63; phase II: 64. Goal categories using both cohorts were assigned to two domains, each subdivided into three key goal categories: Domain 1: body structure impairment 121 (44%): (a) pain/discomfort 34 (12%), (b) involuntary movements 20 (7%), and (c) range of movement/contracture prevention 67 (25%). Domain 2: activity function 149 (56%): (a) passive function (ease of caring for the affected limb) n = 89 (33%), (b) active function (transfers) 26 (10%), and (c) active function (mobility) 27 (10%), other n = 7 (3%). Conclusions: Patients individual leg spasticity goals can be grouped into six categories and two domains, which will assist clinicians, patients and cares in setting and evaluating goals in practice. Implications for Rehabilitation Six goal areas used in clinical goal setting for leg spasticity management were identified, under the two domains: (1) body structure impairment: pain, involuntary movements, and range of movement and (2) activities/function: passive function (ease of caring), active function - transfers or standing and active function - mobility. Categorisation of goals is consistent on repeated evaluation and across different clinical services. Using clinical goals for leg spasticity treatment is an effective method to identify treatment priorities.

Integración del proceso enfermero en la historia clínica electrónica de un hospital universitario / Integration of the nursing process in the electronic health record in an university hospital

Objetivo. Describir el proceso de implantación del Plan de Cuidados Individualizado Enfermero en la Historia Clínica Electrónica y su impacto en el Hospital Universitario Fundación Alcorcón. Metodología. Grupos de trabajo de enfermeras asistenciales que analizaron inicialmente las actividades enfermeras que realizaban habitualmente para crear el catálogo de diagnósticos, resultados e intervenciones. Se creó un grupo de referentes que depuró el catálogo para hacerlo manejable. Se diseñaron un plan de formación, los formularios de valoración enfermera y el Informe de Cuidados Enfermeros al alta. Resultados. En febrero de 2016 se implementó la nueva metodología en las unidades de hospitalización de adultos. Al 74,86-88,18% de los pacientes se les realizó un plan de cuidados con la nueva metodología. Entre un 69,41 y un 76,25% de los pacientes son dados de alta con un Informe de Cuidados Enfermeros conforme a la normativa. Se observó un aumento del 24,13% de los pacientes con Informe de Cuidados Enfermeros tras la implantación (p=0,000; RR 1,46; IC 95% 1,36-1,56). Se ha formado a un total de 116 enfermeras. Conclusiones. En las condiciones del estudio, la utilización de taxonomías enfermeras ha generado capacidad de reflexión y ha permitido emitir juicios enfermeros, aportar calidad de cuidados y aplicar intervenciones con unos resultados planificados. La taxonomía enfermera y el plan de cuidados en la historia clínica electrónica han permitido aumentar la comunicación interprofesional para mejorar la continuidad asistencial, a través de la mejora del Informe de Cuidados Enfermeros (AU)

Aim. To describe the process of implementation of Individualized Care Plan in the Electronic Health Record and its impact on the University Hospital Alcorcón Foundation. Methodology. Working groups of staff nurses who analyzed activities usually performed to create a catalog of diagnoses, outcomes and interventions. A group of referents that refined the catalog to make it manageable was created. A training plan, nursing assessment forms and the Nursing Discharge Report were designed. Results. In February 2016 the new methodology was implemented in inpatient units of adults. Between 74.86 and 88.18% of the patients underwent a care plan with the new methodology. Between 69.41 and 76.25% of patients are discharged with a Nursing Discharge Report accordance with regulations. An increase of 24.1% of patients with Nursing Discharge Report after implantation is observed (P=.000; RR: 1.46; 95% CI 1.36-1.56). A total of 116 nurses has been trained. Conclusions. In the study conditions, the use of nursing taxonomies has generated thinking skills and allowed nurses to issue judgments, ensure quality of care, and implementing interventions with a planned results. The nursing taxonomy and care plan in the Electronic Health Record have increased interprofessional communication to improve continuity of care through improved Nursing Discharge Report (AU)

[Development of a set of nursing-sensitive indicators for Swiss practice]. / Die Entwicklung eines Sets von aufwandrelevanten Pflege-indikatoren für die Schweizer Pflegepraxis.

BACKGROUND: The SwissDRG prospective payment system is known to inadequately account for nursing intensity due to the DRG group criteria insufficiently describing the variability of nursing intensity within individual diagnosis-related groups. In order to allow for appropriate reimbursement and resource allocation, nursing intensity must be able to be explicitly quantified and accounted for. The aim of this project was to develop a set of nursing-sensitive indicators intended to reduce the variation within individual diagnosis-related groups, supplementary to existing SwissDRG group criteria. METHODS: The approach comprised a variety of methods. A systematic literature review, input from an advisory board and an expert panel, as well as three focus group interviews with nurses and nurse managers formed the basis for the synthesis of data and information gathered from these sources. RESULTS: A set of 14 nursing-sensitive indicators was developed. The indicators are intended to improve the homogeneity of nursing intensity within SwissDRG diagnosis-related groups. Before these nursing indicators can be adopted as group criteria, they must be formulated to conform with SwissDRG and tested empirically. CONCLUSION: This set of indicators can be seen at as a first step towards nursing intensity being adequately represented in SwissDRG diagnosis-related groups. The next challenge to be met is operationalising the indicators in codable form.

Validación de la versión en castellano del Nursing Activities Score / Validating the Spanish version of the Nursing Activities Score

Introducción: Validar las escalas es necesario para garantizar que son apropiadas para el objetivo para el que fueron creadas. Objetivo: Validar la versión en castellano del Nursing Activities Score (NAS). Metodología: Estudio observacional y prospectivo que incluye a 1.045 pacientes ingresados en una unidad médico-quirúrgica y una unidad de grandes quemados en 2006. La enfermera encargada del paciente valoró cargas de trabajo mediante el Nine Equivalent of Nursing Manpower use Score y el NAS. Para evaluar la consistencia interna de las mediciones del NAS se calcularon las correlaciones ítem-test, el alfa de Cronbach y alfa de Cronbach corregido, al omitir cada uno de los ítems. La fiabilidad intraobservador y la interobservador se valoraron con el coeficiente de correlación intraclase mediante la visualización de grabaciones y el Kappa (fiabilidad interobservador). Para analizar la validez interna se realizó un análisis factorial de componentes principales, y para la convergente el coeficiente de correlación de Spearman de los valores obtenidos de las escalas Nine Equivalent of Nursing Manpower use Score y NAS-castellano. Resultados: Para la consistencia interna se analizaron 164 cuestionarios calculando un alfa de Cronbach de 0,373. El coeficiente de correlación intraclase para la estimación de la fiabilidad intraobservador fue 0,837 (IC 95%: 0,466-0,950) y 0,662 (IC 95%: 0,033-0,882) para la fiabilidad interobservador. El kappa estimado fue 0,371. Para la validez interna, el análisis factorial exploratorio mostró que el primer ítem explicaba el 58,9% de la varianza del cuestionario. Para la validez convergente se incluyeron 1.006 cuestionarios y se observó un coeficiente de correlación de Spearman de 0,746. Conclusiones: Las propiedades psicométricas del NAS-castellano son aceptables

Introduction: Validating workload scores ensures that they are appropriate for the purpose for which they were developed. Objective: To validate the Nursing Activities Score (NAS) Spanish version. Methodology: Observational and prospective study. 1,045 patients who were admitted to a medical-surgical unit and a serious burns unit in 2006 were included. The nurse in charge assessed patient workloads by Nine Equivalent of Nursing Manpower use Score and NAS. To assess the internal consistency of the measurements of NAS, item-test correlations, Cronbach's alfa and Cronbach's alfa corrected by omitting each of the items were calculated. The intraobserver and interobserver reliability were assessed with the intraclass correlation coefficient by viewing recordings and Kappa (interobserver reliability) was estimated. For the analysis of internal validity, a factorial principal components analysis was performed. Convergent validity was assessed using the Spearman correlation coefficient values obtained from the Nine Equivalent of Nursing Manpower use Score and Spanish-NAS scales. Results: For internal consistency, 164 questionnaires were analysed and a Cronbach's alfa of 0.373 was calculated. The intraclass correlation coefficient for intraobserver reliability estimate was 0.837 (95% IC: 0.466-0.950) and 0.662 (95% IC: 0.033-0.882) for interobserver reliability. The estimated kappa was 0.371. For internal validity, exploratory factor analysis showed that the first item explained 58.9% of the variance of the questionnaire. For convergent validity 1006 questionnaires were included and a Spearman correlation coefficient of 0.746 was observed. Conclusions: The psychometric properties of Spanish-NAS are acceptable

Análisis de la carga de trabajo y uso de los recursos enfermeros en una unidad de cuidados intensivos / Analysis of the workload and the use of the nursing resources in an intensive care unit

Objetivo: Evaluar y valorar mediante 3 escalas las cargas de trabajo enfermero (TE) y determinar la relación enfermera/paciente teórica y real de una UCI polivalente. Metodología: Estudio descriptivo transversal de julio del 2012 a junio del 2013, en pacientes mayores de 18 años, donde en días aleatorizados 3 enfermeras cuantificaron el TE mediante el Nursing Activities Score (NAS), el Nine Equivalents Manpower Score (NEMS) y la Valoración de Cargas de Trabajo y Tiempos de Enfermería (VACTE). Se calcularon parámetros de eficiencia del uso de los recursos enfermeros: «work utilization ratio» (WUR), «level of care» operative (LOCop) y planned (LOCp). Datos demográficos, estancia y número de enfermeras. Resultados: Se recogieron 720 registros. La media de edad fue 64 (13,6) años, el 73% eran hombres y la mediana de estancia de 3 (1-12) días. El 60% ingresaron por patología médica. La media total en puntos fue: NAS696,8 (111,6), NEMS: 311,8 (55,3) y VACTE: 4.978 (897,7). El número de enfermeras requerido según NAS fue de 7, según NEMS y VACTE de 6,7. La media real fue de 5,5. En las 3 escalas el WUR fue > 1 y el LOCop de 1,6 pacientes/enfermera. El LOCp fue de 2 pacientes/enfermera. Conclusiones: Evaluar las cargas de TE posibilita conocer la realidad de cada unidad. Según las escalas y los parámetros de eficiencia del uso de los recursos enfermeros utilizados, existe un déficit de enfermeras con relación al trabajo generado. NAS refleja más parámetros del TE

Objective: To evaluate and assess the nursing workload (NW) scales by means of three scales and to determine the theoretical and real nurse/patient relationship in a polyvalent ICU. Methodology: Cross-sectional descriptive study between July 2012 and June 2013 in patients over 18 years old, for which 3 nurses quantified, in randomized days, the NW by the Nursing Activities Score (NAS), Nine Equivalents Manpower Score (NEMS) and Valoración de Cargas de Trabajo y Tiempos de Enfermería (VACTE). Efficiency parameters of nursing resources were calculated: “work utilization ratio” (WUR), “level of care” operative (LOCop) and planned (LOCp). Data on demographics, length of stay and number of nurses were collected.Results720 records were collected. The mean age was 64 (13.6) years. 73% were male and the median of length of stay was 3 (1- 12) days. 60% were admitted for medical causes. The average total score was NAS: 696.8 (111.6), NEMS: 311.8 (55.3) and VACTE: 4,978 (897.7). The required number of nurses according to NAS was 7 and 6,7 according to NEMS and VACTE. The actual average was 5.5. On all 3 scales the WUR was > 1 and LOCop was 1.6 pacients/nurse. The LOCp was 2 patients/nurse. Conclusion: Assessing NW allows to know the reality of each unit. According to the scales and efficiency parameters of the nursing resources used, there is a shortage of nurses in relation to the work generated. NAS reflects more parameters of NW

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.

Plano de assistência integrada: o enfermeiro frente a um novo modelo de assistência / Plan for integrated care: the nurse facing a new health care model

O estudo tem por objetivo relatar a implantação do plano de Assistência Integrada em um Hospital particular da cidade de São Paulo, enquanto estratégia de gestão que permite o alinhamento das seguintes questões: identificação do grau de complexidade do cuidado; identificação dos riscos inerentes ao paciente e maximização das ações de segurança durante o processo de internação; otimização na alocação dos recursos humanos de enfermagem, de acordo com o grau de dependência dos pacientes em relação à equipe de enfermagem; envolvimento da equipe interdisciplinar no plano de cuidados estabelecidos; organização do cuidado interdisciplinar segundo as necessidades detectadas e singularidade no atendimento ao paciente.

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.

Uso de psicofármacos en el trastorno autista: utilidad, racionalidad y potenciales implementaciones: segunda parte / Use of psychopharmacological drugs in the autistic disorder: usefulness, rationality and potential implementations: second part

La profusa información y postulaciones etiológicas relacionadas con el autismo optimizan su utilidad cuando resultan coherentes entre sí y pueden ser contrastadas con modelos de normalidad. Se trata de una difícil tarea que en los últimos tiempos es abordada con creciente rigurosidad y compromiso. El aporte que la Psicofarmacología puede constituir como parte del tratamiento requiere su contextualización en esta vasta, compleja y dinámica red de hallazgos y teorizaciones.

The abundant information and etiological propositions related with autism optimize its utility when there turns to be coherence between them, and when they can be compared against normality models. It is a difficult task which in recent times has been dealt with increasing thoroughness and commitment. The contribution that Psychopharmacology may constitute as part of the treatment of autism makes it necessary to contextualize it within the vast, complex and dynamic network of findings and theorizations.

Uso de psicofármacos en el trastorno autista: utilidad, racionalidad y potenciales implementaciones: segunda parte / Use of psychopharmacological drugs in the autistic disorder: usefulness, rationality and potential implementations: second part

La profusa información y postulaciones etiológicas relacionadas con el autismo optimizan su utilidad cuando resultan coherentes entre sí y pueden ser contrastadas con modelos de normalidad. Se trata de una difícil tarea que en los últimos tiempos es abordada con creciente rigurosidad y compromiso. El aporte que la Psicofarmacología puede constituir como parte del tratamiento requiere su contextualización en esta vasta, compleja y dinámica red de hallazgos y teorizaciones.(AU)

The abundant information and etiological propositions related with autism optimize its utility when there turns to be coherence between them, and when they can be compared against normality models. It is a difficult task which in recent times has been dealt with increasing thoroughness and commitment. The contribution that Psychopharmacology may constitute as part of the treatment of autism makes it necessary to contextualize it within the vast, complex and dynamic network of findings and theorizations.(AU)

Results of an integrative review of patient classification systems.

This chapter presents the findings of an integrative review of the literature to identify current practices related to patient classification systems (PCSs). We sought to determine if there was a "gold standard" PCS that could be adopted or adapted for use by nurse leaders in practice. Sixty-three articles reporting studies related to PCS, Patient Acuity Systems or Workload Management Systems from 1983 to 2010 and applicable for inpatient medical/surgical settings were reviewed. Generally, we found that many of the criticisms of earlier PCSs are still evident: (1) difficulties with measuring workload remain an overarching theme throughout the literature; (2) definitions and descriptions of nursing work continue to be deemed inadequate; (3) there is insufficient evidence of reliability and validity testing of PCSs; and (4) there is still a need to identify nursing sensitive performance indicators and outcomes. We identified characteristics of promising PCSs, but concluded that no consensus exists about PCSs. We suggest that any approach to predicting staffing should seek to be parsimonious, minimize additional workload, be based on expert nurse judgment, be a true reflection of nursing work, and include indicators that measure patient complexity, required nursing care, available resources, and relevant organizational attributes.

Implementation of standardized nomenclature in the electronic medical record.

PURPOSE: To describe a customized electronic medical record documentation system which provides an electronic health record, Epic, which was implemented in December 2006 using standardized taxonomies for nursing documentation. DATA SOURCES: Descriptive data is provided regarding the development, implementation, and evaluation processes for the electronic medical record system. Nurses used standardized nursing nomenclature including NANDA-I diagnoses, Nursing Interventions Classification, and Nursing Outcomes Classification in a measurable and user-friendly format using the care plan activity. CONCLUSIONS AND IMPLICATIONS: Key factors in the success of the project included close collaboration among staff nurses and information technology staff, ongoing support and encouragement from the vice president/chief nursing officer, the ready availability of expert resources, and nursing ownership of the project. Use of this evidence-based documentation enhanced institutional leadership in clinical documentation.

Evaluation of the implementation of nursing diagnoses, interventions, and outcomes.

PURPOSE: This paper aims to provide insight into nursing classifications and to report the effects of nursing diagnostics implementation. This paper summarizes the results of six studies. METHODS: Two systematic reviews, instrument development and testing, a pre-post intervention study, and a cluster-randomized trial were performed. FINDINGS: The NANDA International classification met most of the literature-based classification criteria, and results showed the Quality of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) to be a reliable instrument to measure the documented quality of nursing diagnoses, interventions, and outcomes. Implementation of standardized nursing language significantly improved the quality of documented nursing diagnoses, related interventions, and patient outcomes. As a follow-up measure, Guided Clinical Reasoning (GCR) was effective in supporting nurses' clinical reasoning skills. CONCLUSIONS: Carefully implementing classifications led to enhanced, accurately stated nursing diagnoses, more effective nursing interventions, and better patient outcomes. IMPLICATIONS: Rethinking implementation methods for standardized language and using GCR is recommended. Based on the results of this study, the inclusion of NANDA International diagnoses with related interventions and outcomes in electronic health records is suggested.

[Nursing classifications and computerized nursing information systems (CNIS): situation and issues]. / Classifications infirmières et systèmes d'information infirmiers informatisés (SIII): état de la situation et enjeux.

Nursing information recorded in a cardex, a nursing care plan or progress notes in a hospital is not saved. As a result, the data cannot be compiled or analyzed, and the nursing profession is deprived of important details that could be used to evaluate the efficiency and effectiveness of nursing interventions. Electronic storage of nursing data using standardized vocabulary (nursing classification systems) would make it possible to codify and use these data. The information obtained would be useful for research, drawing up protocols and practice guides, and even for theory work, to advance nursing knowledge. This article suggests that computerized information systems being deployed in the healthcare network should be based on recognized nursing classifications.