Predicting patient acuity according to their main problem.

AIM: To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step-down units. BACKGROUND: Acuity refers to the categorization of patients based on their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue. METHOD: Cross-sectional, multi-centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated. RESULTS: The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81-0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p < .005). CONCLUSION: The patient main problem predicts acuity. Most inpatients require more intensive than acute nursing care and their outcomes are adversely affected. IMPLICATIONS FOR NURSING MANAGEMENT: Prospective measurement of acuity, considering nurses' clinical judgments on the patient main problem, is feasible and may contribute to support nurse management workforce planning and staffing decision-making, and to optimize patients, nurses and organizational outcomes.

Una terminología interfase como eje de unos cuidados seguros. Nivel de conocimiento y de comprensión de intervenciones enfermeras ATIC(R) / Interface terminology as an axis for safe care: on line questionnaire about knowledge and understanding of ATIC(R) nursing interventions

Introducción. Los lenguajes enfermeros deben contribuir a obtener datos precisos y fiables que faciliten una comunicación eficaz y garanticen unos cuidados seguros. Las terminologías de interfase, como ATIC(R), surgen para complementar las terminologías de referencia y orientan su desarrollo hacia su uso en la práctica clínica. Además, contribuyen a proporcionar información en relación con los conceptos que representan los cuidados con suficiente especificidad clínica que conlleva a un mejor entendimiento entre los miembros del equipo asistencial. Objetivo. Evaluar el nivel de conocimiento y comprensión de las enfermeras acerca de las intervenciones de vigilancia y control de la terminología ATIC(R). Material y métodos. Estudio descriptivo, observacional, transversal y multicéntrico, mediante un cuestionario electrónico validado. Los datos recogidos se analizaron utilizando estadística descriptiva e inferencial. Resultados. Un 85 % de las enfermeras evalúan favorablemente su nivel de conocimientos sobre las intervenciones de vigilancia y control de la terminología ATIC(R). El 51.8 % refiere un nivel de conocimiento superior y el 32.8 % adecuado. Se identificaron diferencias significativas respecto el nivel de conocimientos y el tiempo de uso de ATIC(R), el lugar de trabajo o la asistencia a sesiones clínicas de cuidados (SCS). La evaluación de la comprensión indica que más del 95 % de las participantes tienen una comprensión elevada (75.8 %) o moderada (20.1 %). Además, se identificaron diferencias significativas en relación con la utilización de ATIC(R) durante más de 1 año y la asistencia a SCC. Conclusiones. Las enfermeras que utilizan la terminología ATIC(R) en los registros electrónicos de salud tienen un elevado nivel de conocimiento y comprensión de las intervenciones de vigilancia y control. Las enfermeras entienden los conceptos de forma clara y precisa, lo que contribuye a establecer la fiabilidad del eje de intervención de esta terminología en términos de usabilidad y aumenta la seguridad del proceso de prestación de cuidados (AU)

Introduction. Nursing languages should contribute to obtain ccurate and reliable data to ease effective communication and ensure patients’ safety. Interface terminologies like ATIC(R), arise to complement reference terminologies and are intended to guide their use in clinical settings. Moreover, these terminologies provide information regarding healthcare concepts with sufficient clinical specificity, leading to a better understanding among healthcare team members. Objective. To evaluate nurses’ level of knowledge and understanding in clinical settings surveillance and control interventions of ATIC terminology(R). Materials and methods. A descriptive, observational, cross-sectional, multicenter study was performed administering a validated electronic questionnaire. Collected data was analyzed using descriptive and inferential statistics. Results. 85 % of nurses favorably assessed their knowledge level about surveillance and control interventions of ATIC terminology (R). Higher levels were achieved by 51.8 % and 32.8 % scored as adequate level. Significant differences were found in knowledge level and length of use of terminology, as well as workplace and attendance to clinical care sessions (CCS). The evaluation of understanding indicates that over 95 % of participants have high (75.8 %) or moderate (20.1 %) understanding levels. Furthermore, we found significant differences in relation to the level of understanding and length of time using ATIC(R) (more than 1 year) together with attendance to CCS. Conclusions. Nurses that use the ATIC Terminology© in electronic health records have a high knowledge and understanding level of surveillance and control interventions. Nurses understand the concepts clearly and accurately, what might be considered as an indirect measurement for reliability of the ATIC intervention axis in terms of usability, enhances at the same time safety in the provision process of care (AU)

Detección de necesidades educativas al alta en pacientes con neumonía adquirida en la comunidad / Detection of educational needs at hospital discharge in patients with community-acquired pneumonia

OBJETIVO: identificar las necesidades educativas al alta en pacientes con neumonía adquirida en la comunidad (NAC). MÉTODO: revisión narrativa en la que se realiza una búsqueda bibliográfica de la literatura publicada, desde el año 2000 hasta la actualidad, en las bases de datos Pubmed, CINAHL, Cuiden y Cochrane Library Plus. La búsqueda se efectuó utilizando el lenguaje controlado MeSH, mediante las siguientes palabras clave en inglés: community-acquired pneumonia, patient discharge. Fueron aceptados los artículos que analizaban el consumo de recursos sanitarios posterior al alta hospitalaria (reingresos, consultas a urgencias o mortalidad) y los conocimientos de los pacientes ingresados con NAC. RESULTADOS: fueron analizados 22 estudios que examinaban el consumo de recursos sanitarios posterior al alta hospitalaria (reingresos, consultas a urgencias o mortalidad) y los conocimientos de los pacientes ingresados con NAC. Las principales necesidades educativas del paciente hospitalizado con NAC son las relativas a: hidratación, adherencia al tratamiento farmacológico y vacunas indicadas, conocimiento y control de la enfermedad, actividad física progresiva, abandono de hábitos tóxicos y manejo de las comorbilidades. CONCLUSIONES: las necesidades educativas detectadas deben incluirse en programas educativos previos al alta hospitalaria en pacientes con NAC para mejorar el manejo de la enfermedad y disminuir el consumo de recursos sanitarios posterior al alta

OBJECTIVE: to identify the educational needs at hospital discharge in patients with Community-Acquired Pneumonia (CAP). METHOD: a narrative review where a bibliographic search was conducted on published literature, from year 2000 to the present day, in the Pubmed, CINAHL, Cuiden and Cochrane Library Plus databases. The search was conducted using the MeSH controlled vocabulary, through the following key words in English: community-acquired pneumonia, patient discharge. Articles were accepted on Use of Healthcare Resources after Hospital Discharge (re-hospitalizations, visits to the Emergency Unit or mortality), and knowledge of patients hospitalized with CAP. RESULTS: 22 studies were analyzed, which examined the use of healthcare resources after hospital discharge (re-hospitalizations, visits to the Emergency Unit or Mortality), and the level of knowledge of patients hospitalized with CAP. The main educational needs of patients hospitalized with CAP were those associated with hydration, adherence to pharmacological treatment, and vaccine indications, awareness and monitoring of the disease, progressive physical activity, giving up toxic habits, and management of comorbidities. CONCLUSIONS: the educational needs detected must be included in educational programs previous to hospital discharge in patients with CAP, in order to improve the disease management, and reduce the use of healthcare resources after discharge

Mapping the Diagnosis Axis of an Interface Terminology to the NANDA International Taxonomy.

Background. Nursing terminologies are designed to support nursing practice but, as with any other clinical tool, they should be evaluated. Cross-mapping is a formal method for examining the validity of the existing controlled vocabularies. Objectives. The study aims to assess the inclusiveness and expressiveness of the nursing diagnosis axis of a newly implemented interface terminology by cross-mapping with the NANDA-I taxonomy. Design/Methods. The study applied a descriptive design, using a cross-sectional, bidirectional mapping strategy. The sample included 728 concepts from both vocabularies. Concept cross-mapping was carried out to identify one-to-one, negative, and hierarchical connections. The analysis was conducted using descriptive statistics. Results. Agreement of the raters' mapping achieved 97%. More than 60% of the nursing diagnosis concepts in the NANDA-I taxonomy were mapped to concepts in the diagnosis axis of the new interface terminology; 71.1% were reversely mapped. Conclusions. Main results for outcome measures suggest that the diagnosis axis of this interface terminology meets the validity criterion of cross-mapping when mapped from and to the NANDA-I taxonomy.