Angelita Paganin

Factors that inhibit the use of nursing language.

PURPOSE The purpose of this study was to identify the impact of institutional, professional, and personal factors on nurses and on their efforts to make nursing diagnoses. METHODS A cross-sectional study was conducted in which all participants completed a questionnaire established to measure each individual group of factors. A score (0-100) was established to measure each group of factors. RESULTS Twenty-one nurses responded that their busy shifts, the number of patients per nurse, and their involvement with administrative tasks were the three parameters most frequently identified as interfering with implementing nursing diagnosis. CONCLUSION The recognition of these factors and improved institutional support may facilitate the implementation of nursing diagnoses. PRACTICE IMPLICATIONS Electronic records may contribute to the implementation of the nursing process, particularly if the identified signs and symptoms are documented and then linked to nursing diagnoses and interventions.

Implantação do diagnóstico de enfermagem em unidade de terapia intensiva: uma análise periódica

Knowledge about the prevalence of nursing diagnosis (ND) helps to provide the necessary care and to guide continuing education programs. This cross-sectional study aimed to identify the main nursing diagnosis (ND) prescribed in intensive care units (ICU) and to compare them with medical and surgical patients. Data analysis was performed according to the North American Nursing Diagnoses Association (NANDA) Taxonomy II. In the 150 medical records evaluated were found 195 nursing diagnoses, with an average of 1.3 per patient, mainly in the protection and security domain (39.5%). The most common ND were: impaired tissue integrity (22%), impaired gas exchange (22%), ineffective cerebral tissue perfusion (8.7%), impaired skin integrity (7.7%), decreased cardiac output (6.7%) and ineffective tissue perfusion cardiopulmonary (6.1%). The most prevalent nursing diagnoses revealed the physiological needs as the most common in our sample.

Clinical validation of the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to cardiac catheterization

AIM To validate, clinically, the defining characteristics for the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to heart catheterization and to validate acute pain, haematoma, bleeding, redness, and heat as additional characteristics. BACKGROUND In clinical practice, an applicable nursing diagnosis for patients subjected to diagnostic heart catheterization has not been well-defined. DESIGN Cross-sectional. METHODS This clinical validation study using Fehrings model was performed at a Brazilian general hospital between November 2009-November 2010. This study included 250 patients who received elective femoral artery catheterization. Each patient was identified as having two characteristics of Impaired Tissue Integrity and three characteristics of Impaired Skin Integrity, according to NANDA-I nursing diagnoses. Due to certain postprocedure events, five additional characteristics were added to be validated in this setting. In addition to Fehrings reliability rating, the kappa coefficient was used to evaluate inter-rater agreement during the clinical evaluation. RESULTS The defining characteristic of damaged tissue was validated for Impaired Tissue Integrity and the defining characteristics of the invasion of body structures and the disruption of the skin surface were validated for Impaired Skin Integrity. Although the five characteristics that were added to the investigated diagnoses were not validated because of their low rate of occurrence in this setting, the measurements of acute pain, haematoma, bleeding, redness, and heat each had excellent inter-rater agreement. CONCLUSION The validation of characteristics from both of these diagnoses suggested that these criteria could be utilized for clinical practice in a diagnostic setting. Moreover, additional characteristics should also be observed to better guide nursing intervention.

A Vascular Complications Risk (VASCOR) score for patients undergoing invasive cardiac procedures in the catheterization laboratory setting: A prospective cohort study

Background: Vascular complications are still common in the catheterization laboratory setting. However, no risk scores for their prediction have been described. With a view to bridging this gap, the present study sought to develop and validate a score for prediction of vascular complications associated with arterial access in patients undergoing interventional cardiology procedures. Methods: This prospective multicenter cohort study included adult patients who underwent cardiac catheterization via the femoral or radial route. The outcomes of interest were: access site hematoma; major and minor bleeding; and retroperitoneal hemorrhage, pseudoaneurysm, or arteriovenous fistula requiring surgical repair. Past medical history as well as pre-procedural, intra-procedural, and post-procedural variables were collected. Patients were randomly allocated to the derivation or validation cohorts at a 2:1 ratio. The following equation constituted the score: (>6F introducer sheath×4.0)+(percutaneous coronary intervention×2.5)+(history of vascular complication after prior interventional cardiology procedure×2.0)+(prior use of warfarin or phenprocoumon×2.0)+(female sex×1.5)+(age⩾60 years×1.5). The maximum score is 13.5 points. Results: A score dichotomized at ⩾3 (best cutoff for balancing sensitivity and specificity) was moderately accurate (sensitivity=0.66 (95% confidence interval: 0.59–0.73); specificity=0.59 (95% confidence interval: 0.56–0.61)). Patients with a score ⩾3 were at increased risk of complications (odds ratio: 2.95; 95% confidence interval: 2.22–3.91). Conclusions: This study yielded a score that is capable of predicting vascular complications and easily applied in daily practice by providers working in the catheterization laboratory setting.

Implementation of nursing diagnosis in the intensive care unit: a periodic review

Knowledge about the prevalence of nursing diagnosis (ND) helps to provide the necessary care and to guide continuing education programs. This cross-sectional study aimed to identify the main nursing diagnosis (ND) prescribed in intensive care units (ICU) and to compare them with medical and surgical patients. Data analysis was performed according to the North American Nursing Diagnoses Association (NANDA) Taxonomy II. In the 150 medical records evaluated were found 195 nursing diagnoses, with an average of 1.3 per patient, mainly in the protection and security domain (39.5%). The most common ND were: impaired tissue integrity (22%), impaired gas exchange (22%), ineffective cerebral tissue perfusion (8.7%), impaired skin integrity (7.7%), decreased cardiac output (6.7%) and ineffective tissue perfusion cardiopulmonary (6.1%). The most prevalent nursing diagnoses revealed the physiological needs as the most common in our sample.

Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study

ABSTRACT Objective: to analyze vascular complications among patients who underwent endovascular cardiac procedures in the hemodynamic laboratories of three referral centers. Method: a multicenter cohort study was conducted in three referral facilities. The sample was composed of 2,696 adult patients who had undergone elective or urgent percutaneous cardiac procedures. The outcomes were vascular complications, such as: hematoma at the site of the arterial puncture; major or minor bleeding; surgical correction for retroperitoneal hemorrhage; pseudoaneurysm; and arteriovenous fistula. Results: 237 (8.8%) of the 2,696 patients presented a vascular complication at the site of the arterial puncture. The total number of vascular complications was 264: minor hematoma<10cm (n=135); stable bleeding (n=86); major hematoma ≥10cm (n=32); and unstable bleeding (n=11). There were no retroperitoneal hematoma events, pseudoaneurysm or arterial venous fistula. Most of the major and minor complications occurred in the first six hours after the procedure. Conclusion: the results concerning the current context of interventional cardiology indicate that the complications predominantly occur in the first six hours after the procedure, considering a 48-hour follow-up. The staff should plan and implement preventive measures immediately after the procedures.

Nursing Interventions and Outcomes for the Diagnosis of Impaired Tissue Integrity in Patients After Cardiac Catheterization: Survey.

PURPOSE Determine the outcomes and interventions for patients undergoing cardiac catheterization with nursing diagnosis of impaired tissue integrity. METHODS Survey with e-questionnaires sent for expert nurses in two rounds. FINDINGS Only one nursing outcome was approved: tissue integrity-skin and mucosa and five related interventions, namely, pressure control, topical drug administration, care of incision site, care of injuries, and infection control. CONCLUSIONS The expected outcomes and the most significant interventions for the implementation of nursing care during the immediate recovery of patients with impaired tissue integrity following invasive hemodynamic procedures were defined. IMPLICATIONS FOR NURSING PRACTICE The study findings support selection of appropriate nursing outcomes and interventions for this patient profile.

A Clinical Validation Study of Impaired Physical Mobility of Patients Submitted to Cardiac Catheterization

PURPOSE   To conduct a Fehring model-based clinical validation of the defining characteristics of the nursing diagnosis of impaired physical mobility in a sample of 250 patients. METHOD   Cross-sectional study. FINDINGS   Three of the 11 NANDA-International defining characteristics assessed in this study were validated: limited range of motion, limited ability to perform gross motor skills, and difficulty turning. Although discomfort was not validated due to the rarity of occurrence, there was excellent interrater agreement as to its relevance (kappa coefficient). CONCLUSIONS   In this setting, three characteristics were validated. IMPLICATIONS FOR NURSING PRACTICE   Validation studies are important for advancing evidence-based practice.PURPOSE:  To conduct a Fehring model-based clinical validation of the defining characteristics of the nursing diagnosis of impaired physical mobility in a sample of 250 patients. METHOD:  Cross-sectional study. FINDINGS:  Three of the 11 NANDA-International defining characteristics assessed in this study were validated: limited range of motion, limited ability to perform gross motor skills, and difficulty turning. Although discomfort was not validated due to the rarity of occurrence, there was excellent interrater agreement as to its relevance (kappa coefficient). CONCLUSIONS:  In this setting, three characteristics were validated. IMPLICATIONS FOR NURSING PRACTICE:  Validation studies are important for advancing evidence-based practice.

Aplicación de diagnóstico de enfermería en la unidad de cuidados intensivos: una revisión periódica

Knowledge about the prevalence of nursing diagnosis (ND) helps to provide the necessary care and to guide continuing education programs. This cross-sectional study aimed to identify the main nursing diagnosis (ND) prescribed in intensive care units (ICU) and to compare them with medical and surgical patients. Data analysis was performed according to the North American Nursing Diagnoses Association (NANDA) Taxonomy II. In the 150 medical records evaluated were found 195 nursing diagnoses, with an average of 1.3 per patient, mainly in the protection and security domain (39.5%). The most common ND were: impaired tissue integrity (22%), impaired gas exchange (22%), ineffective cerebral tissue perfusion (8.7%), impaired skin integrity (7.7%), decreased cardiac output (6.7%) and ineffective tissue perfusion cardiopulmonary (6.1%). The most prevalent nursing diagnoses revealed the physiological needs as the most common in our sample.

Nursing interventions implemented according to the most prevalent nursing diagnoses in intensive care: cross-sectional study

Context: Evaluating clinical practice based on standard language has become a necessity. Objective: This study aims to map nursing interventions according to the Nursing Interventions Classification (NIC), identifying the most prevalent Nursing Diagnoses in an intensive care unit within the first 24 hours of hospital admission. Method: Cross-sectional study. A cross-mapping method was used to analyze data collected from 150 medical records. A total of 195 diagnoses were identified, showing 21 different ones; and 1694 prescribed care. Result: The most recurrent diagnoses were Impaired Tissue Integrity and Impaired Skin Integrity, and the main intervention, Lesion Care (14.1% and 19.78%) was prescribed for both; Gas Exchange was affected by prevailing intervention Airway Control (29.76%), Ineffective Tissue Perfusion: cerebral and cardiopulmonary with priority intervention Neurologic Monitoring (38.3%) and Acute Cardiac Care (2.8%) respectively, the latter also being priority for Decreased Cardiac Output (1.3%). Conclusion: Most care was in line with the standard taxonomy of the Nursing Interventions Classification, though the interventions considered priority were limited.