Relevance of NANDA and health promotion diagnoses to school nursing. National Association of School Nurses

This is a report of a national survey of 490 members of the National Association of School Nurses which described the relevance of 109 nursing diagnoses approved by NANDA (1992) and 29 health promotion (wellness) diagnoses developed by the authors. The relevance of these 138 nursing diagnoses for school nursing was determined by the percent of participants who checked "Yes" for the diagnostic categories they observed in their practice and for which they provided one or more interventions. More than half of the sample checked "Yes" for 67 NANDA diagnoses; health promotion diagnoses were checked "Yes" by 45% to 89% of the sample. The implications are that NANDA and health promotion diagnoses are relevant to school nursing and could readily be incorporated into practice to facilitate data collection that supports both the funding of school nurses and program development for children, families, and school staff.     

The concept and potentials of cardiovascular gene therapy

TOPIC: A nursing theory framework for teaching health assessment. PURPOSE: To improve teaching of health assessment and nursing process to beginning-level baccalaureate nursing students. SOURCES: The Assessment and Analysis Guideline Tool, published and unpublished literature, personal observation, and faculty feedback were used in tool development. CONCLUSIONS: Faculty concluded that students who could envision the connection of the Neuman Systems Model and NANDA nursing diagnoses through the nursing process would be better able to understand the nursing model and choose appropriate nursing diagnoses for client care.     

An exploration of the nursing diagnosis terminal syndrome

As a result of the limitations of a single nursing diagnosis, NANDA has encouraged the development of "syndromes." A study was undertaken using an investigator-developed tool to identify the cluster of defining characteristics, nursing diagnoses and nursing interventions for terminally ill patients, regardless of disease origin. The sample consisted of completed medical records of 15 randomly selected chronic obstructive pulmonary disease patients and 15 randomly selected cancer patients. For all three areas there were commonalities, specifically 10 defining characteristics, seven nursing diagnosis and a 27%-48% agreement on the nursing interventions selected. A clustering of data has been documented to support the establishment of the nursing diagnosis, terminal syndrome.     

Utilization of nursing diagnosis according to Nanda's classification for the systematization of nursing care in breast feeding

The present study aimed at describing the reformulated instrument used in the puerperal woman nursing consultation based on the identified diagnoses classification according to the Taxonomy-I reviewed by NANDA, and the identification of the most frequent nursing diagnoses concerning maternal breastfeeding, based on the reformulated instrument. The diagnoses found as being over 50% were: knowledge deficit (100%); sleep pattern disturbance (75%), altered sexuality patterns (75%), ineffective breastfeeding (66.6%) and impaired physical mobility (66.6%).     

Implications of nursing taxonomies for middle-range theory development

Given the broad acceptance for the need to develop middle-range theory to support nursing practice, nursing scientists must consider how to proceed with dispatch to develop these theories. This article suggests using the concepts in the newly developing taxonomies of nursing knowledge as the building blocks for these theories. Taxonomies of nursing diagnoses (NANDA), nursing interventions (NIC), and nursing outcomes (NOC) can speed the construction of the theories needed for nursing practice.     

Characteristics of the leadership of health center coordinators in the autonomous community of Murcia

OBJECTIVE: To describe the style and effectiveness (adaptability) of the leadership of coordinators of an autonomous community according to the model of leadership on the ground, analysing its relationship with the work environment. DESIGN: Observational crossover study. SETTING: All the functioning teams in this community. PARTICIPANTS: Medical and nursing coordinators. MEASUREMENTS AND MAIN RESULTS: Hersey and Blanchard's questionnaire on leadership on the ground was employed. This identifies 1) the predominant style (scoring for style 0-12). On the approach of the coordinator to personal relationships and/or task development, it identifies 4 points: direction, persuasion, participation, delegation. 2) Adaptability of the manager (ranging from +24 to -24), based on that the best choice between different options depends on the maturity of the group. To contrast work environment and leadership, a validated questionnaire, adapted to our milieu, was used. Overall reply rate (51 coordinators) was 89.4%. Analysis of styles was: persuasive 5.05 points (SD = 1.25), participatory 4.74 (SD 1.76), directive 1.2 (SD 1.11) and delegating 0.34 (SD 0.68). Adaptability scored 8.38 points (SD = 4.67), and was greater for the nursing coordinators (p < 0.002) without differences for type, place or teaching qualifications. The work environment, both overall and by dimensions, correlated with adaptability, although no relationship was found with leaders' styles. CONCLUSIONS: Leadership adaptability was quite high and greater in nursing. The most prevalent styles were the persuasive and the participatory, more efficacious in teams of average maturity. Theoretical effectiveness was positively related to a better work environment.     

Implementing nurse sensitive outcomes into care planning at a long-term care facility

This article describes one long-term care facility's efforts to implement standardized language in the care planning process. Federal regulations for long-term care mandate the use of a uniform comprehensive assessment tool. Eighteen Resident Assessment Protocols (RAPs) are identified for data collection. Computer databases were revised for care planning. Appropriate North American Nursing Diagnosis Association (NANDA) diagnoses were linked to each RAP. Nursing-Sensitive Outcomes (NOCs) were linked to each NANDA as goals. Nursing Interventions Classifications (NICs) were linked to NANDA diagnosis and NOC outcomes as approaches. The databases are illustrated, and frequently used NANDAs and NOCs are identified.     

The influence of nursing diagnosis on information processing by undergraduate students

PURPOSE: To examine the influence of a nursing diagnosis course on the information processing by undergraduate students. METHODS: A quasi-experimental study conducted with two groups (experimental, n = 15; control, n = 22) of undergraduate nursing students, subjecting only one to a nursing diagnosis course. The students' ability to identify, cluster, and name clusters of relevant data were compared between and within groups. FINDINGS: After the course, the experimental group performed better than the control group in the three activities studied. CONCLUSIONS: The results of this study suggest that the nursing diagnosis content in teaching favors clinical reasoning to determine the patient's nursing care.     

The effect of a rapid kit for detection of streptococcal pharyngitis on the accuracy of the physicians' diagnoses

BACKGROUND: In the last decade, the accuracy of rapid tests for detection of group A streptococcal antigen was evaluated in laboratory and clinical settings, and the tests were suggested as an alternative to the traditional throat culture. METHODS: We evaluated 19 patients with a preliminary diagnosis of nonstreptococcal pharyngitis and 13 patients with a preliminary diagnosis of streptococcal pharyngitis. The physician performed a rapid latex agglutination test (Detect A Strep), took throat culture from all of the patients, reconsidered the preliminary diagnosis, and made a working diagnosis. A clinical score was calculated for each patient during data analysis. The accuracy of the physicians' preliminary diagnoses was compared with the accuracy of the scoring system, with the accuracy of the latex agglutination test, and with the accuracy of the physicians' working diagnoses. RESULTS: The scoring system, the physicians' preliminary diagnoses, the latex agglutination test, and the physicians' working diagnoses correlated significantly with throat culture results (p < or = 0.05). The efficiency of the physicians' preliminary diagnoses was 75% compared with an efficiency of 69% of the clinical scoring system, an efficiency of 66% of the latex agglutination test, and an efficiency of 69% of the physicians' working diagnoses. The physician changed the preliminary diagnosis only for two patients as a result of the latex agglutination test results; ironically, however, the preliminary diagnosis was correct in both of these cases. CONCLUSION: The use of a rapid test for the diagnosis of group A streptococcal antigen under normal working conditions did not improve the accuracy of the physician's diagnosis, so the use of the latex agglutination test in this study was not cost-effective.     

Identification of nursing management diagnoses

Theories from nursing and management provide frameworks for enhancing effectiveness of nursing management practice. The concept nursing management diagnosis has been developed by integrating nursing diagnosis and organizational diagnosis as a basis for nurse manager decision-making. Method triangulation was used to identify problems of managing nursing units, to validate those problems for relevancy to practice, to generate nursing management diagnoses, and to validate the diagnoses. Diagnoses were validated according to a definition of nursing management diagnosis provided. Of the 72 nursing management diagnoses identified, 66 were validated at a 70% level of agreement by nurse managers participating in the study.     

Low-grade fever of protracted course. Retrospective study of 30 cases and reflections for a low-cost management

The objects of this paper were the following: 1) to establish in a group of persistent (over four weeks) low grade fever (LGF) patients the percentage of cases in which a definite diagnosis could not be made; 2) where a definite diagnosis could be made, to describe the most commonly occurring diseases; 3) to follow up the uncertain diagnosis cases for at least two years. Thirty cases of persistent LGF were retrospectively studied. They did not include drug hyper-dysthermia and temporary and/or metabolic vasomotor reactions. The data suggest that: 1) two thirds of persistent LGF are likely not to be definitely diagnosed; 2) some certain diagnoses were: dental granulomas, mycobacteria infections, thyroiditis, factitious fever, rheumatic polymyalgia, Hodgkin's lymphoma and pulmonary thromboembolism; 3) in 14/19 undiagnosed cases the fever subsided permanently, without any treatment, within one year, whereas it persisted in 5/19, but no deterioration of the overall clinical status was observed; 4) although some of the undiagnosed cases were examined elsewhere, a certain diagnosis was never achieved in spite of their undergoing sophisticated and expensive clinical, laboratory and X-ray tests. Therefore it is concluded that: 1) persistent LGF should be managed more conservatively than fever of unknown origin so as to preserve resources; 2) some diseases should be included in the differential diagnoses from the beginning of the initial clinical work up; 3) undiagnosed LGF fever either subsides and returns to normal within one year or the fever persists, but no deterioration of the clinical and performance status is likely to occur.     

Residential care placement: perceptions among elderly Chinese people in Hong Kong

BACKGROUND: The optimal criteria for the diagnosis of migraine without aura in children are controversial. One strategy for assessing the validity of diagnostic criteria is to compare them with expert clinical diagnoses. OBJECTIVE: To study the agreement between clinical headache diagnoses assigned by pediatric neurologists and symptom-based diagnoses using the International Headache Society (IHS) criteria as well as alternative case definitions. METHODS: We reviewed the records of 253 children and adolescents consecutively evaluated by pediatric neurologists at the Montefiore Headache Unit. Clinical diagnoses assigned by the physicians were used as the gold standard in evaluating the validity of the IHS criteria for the diagnosis of migraine without aura. Alternative symptom-based diagnoses were compared with the clinical gold standard. RESULTS: Detailed headache histories were abstracted from charts of 253 children; 167 children had complete data on all features required for IHS diagnosis. Eighty-eight (52.7%) children received a diagnosis of migraine without aura. Using the clinical diagnosis as the gold standard, the IHS criteria had a sensitivity of 27.3% and a specificity of 92.4%. The poor sensitivity of the IHS definition is a consequence of the rarity of certain features in children clinically diagnosed with migraine: duration of 2 hours or longer (55.7%), unilateral pain (34.1%), vomiting (47.7%), and phonophobia (27.3%). Based on these findings we suggested a definition for pediatric migraine headache without aura that is less complex, more sensitive (71.6%), and almost as specific as the IHS criteria. CONCLUSIONS: The IHS criteria for migraine without aura have poor sensitivity but high specificity using a clinical diagnosis as the gold standard. The IHS criteria should be modified to better reflect current pediatric clinical practice.     

Fluid volume deficit: profile of defining characteristics in patients with burns

The present study aimed at describing the profile of defining characteristics in patients with the nursing diagnosis "Fluid volume deficit" related to active loss of fluid secondary to burns. Data were collected by means of a tool, containing 29 possible defining characteristics of this diagnosis. Seven nurses, that worked at the Burnt Unit for at least five years ago, provided opinions about the degree to which each defining characteristic is indicative of this diagnosis. Nurses rated each defining characteristic of diagnosis being tested on a scale of zero to one. The results confirmed all, except one (increased body temperature) defining characteristics presented by NANDA for this diagnosis and indicated 10 new defining characteristics.     

Lymphocyte phenotyping in infants: maturation of lymphocyte subpopulations and the effects of HIV infection

Oxygen administration is one of the most important therapeutic interventions for a child with severe acute lower respiratory tract infection (ALRI). Inexpensive and efficient methods of oxygen administration are highly desirable in hospitals in developing countries. The objectives of this study were to compare the frequency and nature of complications when nasopharyngeal catheters or nasal prongs are used to deliver oxygen. One hundred and twenty-one children between the ages of 2 weeks and 5 years with hypoxia due to ALRI were randomized to receive oxygen via a catheter (61 children) or via nasal prongs (60 children). The two groups were similar in terms of diagnoses, clinical severity, oxygen saturation on admission and case fatality rates. There was no difference in the incidence of hypoxaemic episodes between the two groups. The oxygen flow rates required on the day of admission for adequate oxygenation (SaO2 > 90%) ranged from 0.8 litres per minute to 1.2 litres per minute. The required oxygen flow rate decreased during the course of treatment. Mucus production was more of a problem in the catheter group, and nasal blockage, intolerance of the method of oxygen administration and nursing effort were generally higher amongst the catheter group, but none of these differences was significant. Ulceration or bleeding of the nose was significantly more common in the catheter group (19.7% vs 6.7%, p < 0.05). Abdominal distension and nasal perforation were not seen in either group. This study suggests that nasal prongs are safer, more comfortable and require less nursing expertise than nasopharyngeal catheters for administration of oxygen to children.     

Comparative profitability of hepatic biopsy and microbiological tests in patients with HIV infection

OBJECTIVES: Diagnostic liver biopsy is proposed in HIV-positive patients who present unexplained fever. This invasive procedure is truly useful if it allows establishing a difficult diagnosis or improves survival rate. We conducted a retrospective study to determine the diagnostic and prognostic power of liver biopsy in HIV-positive patients with fever. METHODS: One hundred thirty-eight liver biopsies were performed in 129 patients. Utility was defined as demonstration of the pathogen or identification of a tumoral process. RESULTS: The liver biopsy met the utility criteria in 27 cases showing mycobacterial infections (n = 22) and herpes hepatitis, type 1 herpes simplex virus, cytomegalovirus and cryptococcosis infections (n = 1 each). These last 4 diagnoses were also possible with other tests. Comparing non-contributive liver biopsies (n = 111) with those demonstrating hepatic mycobacterial infection (n = 22) showed that the two groups were not different in terms of demographic data. Splenomegalia was more frequent in the non-contributive group (68% vs 37%, p = 0.007) as was superficial lymph node enlargement (45% vs 12%, p < 10(-3)). Laboratory tests were not discriminating. Mycobacterial infection was diagnosed in 22 patients in the non-contributive group. Bacteriological samples were positive for mycobacterium in 20 of the 22 patients in the contributive group. The mean delay to the first positive test for mycobacterium was 15 +/- 8 days compared with 30 +/- 10 days for liver tissue cultures. Mean survival after liver biopsy was 10 months: patients with a positive Ziehl-Neelson stain on the liver biopsy did not have a longer survival (9.7 +/- 7.6 vs 10.2 +/- 10.4 months). CONCLUSION: In most cases, liver biopsy in HIV-positive patients with fever provides a diagnosis which can be obtained with non-invasive techniques without improving prognosis.     

Thirty one-year durability of a Starr-Edwards aortic prosthesis

BACKGROUND: Endoscopic diagnosis of short segments of Barrett's epithelium (SSBE)' is difficult and its meaning in terms of the presence of specialised columnar epithelium (SCE) has not been prospectively evaluated. AIMS: To evaluate the prevalence of SCE in patients with an endoscopic diagnosis of SSBE and in individuals with normal appearing oesophagogastric junctions, and to compare the clinical characteristics of these two groups. PATIENTS: Thirty one patients with an endoscopic diagnosis of short Barrett's oesophagus, less than 3 cm in length (group A), and 44 consecutive patients with normal appearing oesophagogastric junctions (group B). METHODS: Multiple biopsies were performed in suspicious epithelium and at the oesophagogastric junction in groups A and B, respectively. RESULTS: Age and sex distribution were similar in both groups. Reflux symptoms were more frequent in group A (p < 0.001), as were endoscopic and histological signs of oesophagitis (p < 0.001 and p = 0.001, respectively). SCE was found in 61.3% of group A patients compared with 25% in group B (p < 0.002), with men predominating in group A while women were more frequent in group B (p = 0.02). The differences in reflux symptoms and endoscopic/histological oesophagitis remained significant. CONCLUSIONS: These results show that endoscopic diagnosis of SSBE is associated with a high prevalence of SCE, significantly higher than that found in normal appearing oesophagogastric junctions. Differences between patients with SCE in the two groups suggest they may represent two different entities.     

Endothelium-independent relaxant effect of 5-hydroxytryptamine (5-HT) on the isolated rabbit facial vein

PURPOSE: To identify nursing diagnoses and interventions applicable for post-acute-phase battered women. METHODS: Eight battered women were interviewed twice for 2 hours. Gordon's functional health patterns provided the framework for data collection. FINDINGS: Fifty-three nursing diagnoses and 52 nursing interventions were indicated in the data; 24 nursing diagnoses and 26 nursing interventions were present in all participants' data. CONCLUSIONS: With the use of comprehensive interventions, nurses can make a major contribution to society by enabling battered women to move to a more protected lifestyle.     

Patient management in geriatric psychiatry by ambulatory care services. Results of an empirical analysis

This study was designed to provide information to which extend home-based nursing care services for the elderly take part in the care for older people with mental disorders. Also of interest was the involvement of clinical facilities and services of the geropsychiatric treatment system in the health care for the clients. A one day data collection in 29 nursing care services in two North Rhine-Westphalian regions could raise informations about 1,246 clients aged 60 years and over 1,522 persons (41.8%) had a mental disorder, diagnosed by a nursing and/or medical professional. 68% of the mental disordered clients had dementia or a demential disorder, 6% a functional psychosis, and 31% a neurotic, psychogenic disorder or substance abuse (small number of clients with two and more diagnoses). 82% of clients with mental disorders had one or more additional somatic disease(s). These diseases were mostly the cause for the involvement of home-based nursing care service. Barely 8% of clients with mental disorders were placed from clinical facilities and services of the geropsychiatric treatment system into the nursing care services. Beside the home-based care, only a 12% of mental disordered received clients outpatient psychiatric treatment. Systematic cooperation between the nursing care services and the system of (gero-) psychiatric treatment was a rare exception.     

Multicenter randomized clinical trial of home uterine activity monitoring: pregnancy outcomes for all women randomized

OBJECTIVE: Our purpose was to evaluate the impact of home uterine activity monitoring on pregnancy outcomes among women at high risk for preterm labor and delivery. STUDY DESIGN: Women at high risk for preterm labor at three centers were randomly assigned to receive high-risk prenatal care alone (not monitored) or to receive the same care with twice-daily home uterine activity monitoring without increased nursing support (monitored). There were 339 women with singleton gestations randomized with caregivers blinded to group assignment. The two groups were medically and demographically similar at entry into the study. RESULTS: Women in the monitored group had prolonged pregnancy survival (p = 0.02) and were less likely to experience a preterm delivery (relative risk 0.59; p = 0.04). Infants born to monitored women with singleton gestations were less likely to be of low birth weight (< 2500 gm; relative risk 0.47, p = 0.003), and were less likely to be admitted to a neonatal intensive care unit (relative risk 0.5, p = 0.01). CONCLUSION: These data show, among women with singleton gestations at high risk for preterm delivery, that the use of home uterine activity monitoring alone, without additional intensive nursing care, results in improved pregnancy outcomes, including prolonged gestation, decreased risk for preterm delivery, larger-birth-weight infants, and a decreased need for neonatal intensive care.