Intensive Care Nursing Scoring System Part 2: nursing interventions and nursing outcomes

Sleep and nursing care activities in an intensive care unit

This study aimed to describe the quality of sleep of non-intubated patients and the night-time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non-intubated, non-sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes. The portion of deep non-rapid-eye-movement (non-REM) sleep varied from 0% to 42% and REM sleep from 0% to 65%. The frequency of arousals and awakenings varied from two to 73 per hour. The median amount of nursing care activities was 0.6/h. Every tenth activity presumably awakened the patient. Patients who had more care activities had more light N1 sleep, less light N2 sleep, and less deep sleep. Nursing care was often performed while patients were awake. However, only 31% of the intervals between nursing care activities were over 90 min. More attention should be paid to better clustering of care activities.

[The meaning of standardized language NANDA-NIC-NOC intensive care nurses in Madrid: a phenomenological approach]

Nursing standardized language is a tool that makes it possible to integrate a theoretical framework of problem identification, interventions and outcomes in care. Its use in the difference care settings is varied. In the case of intensive care units, it is necessary to study the implications that integration of this language would have in nursing area.

OBJECTIVE

To describe the meaning of standardized NANDA-NIC-NOC language for the nurses working in Intensive Care Units in Madrid.

METHOD

A phenomenological qualitative study was conducted.

INCLUSION CRITERIA

ICU in Madrid of nurses with one year or more experience at the time of the study who were working in the ICU.

SAMPLE

Purposive and Snowball sampling technique.

DATA COLLECTION

Unstructured interviews, personal documents (letters, diaries). Interviews were recorded and transcribed verbatim for later analysis.

ANALYSIS

Giorgi proposal. Identifying meaning units, groups of common senses and themes.

RESULTS

Three themes made up the meaning of standardized language in intensive care nursing. "Living integrating 2 sides of the same coin", "living a conceptual imposition", and "living a development opportunity and professional autonomy".

CONCLUSIONS

There is a gap in the theory of language and its clinical application. Nurses report feeling imposition of a specific conceptual language. This creates the construction of a hierarchy between nurses based on the use of NANDA-NIC-NOC. Even so, the standardized language is experienced as a professional development opportunity.

Demand for nursing care for patients in intensive care units in Southeast Poland

BACKGROUND

The Therapeutic Intervention Scoring System is widely used in both Western Europe and the United States to assess the level of patients' need for nursing care. Poland currently has 3 types of intensive care according to a territorial division of the country and the scope of medical treatment offered: poviat, voivodeship, and clinical.

OBJECTIVE

To determine the need for nursing care for patients in the 3 types of intensive care units in southeastern Poland.

METHODS

The investigation was conducted at 6 intensive care units in southeastern Poland in 2005 and 2006. Two units were randomly selected from each type of intensive care unit. A total of 155 patients from the units were categorized according to scores on the Therapeutic Intervention Scoring System 28.

RESULTS

Among the 3 types of units, patients varied significantly with respect to age, length of hospitalization, and scores on the Therapeutic Intervention Scoring System 28. Nevertheless, demand for nursing care during night and day shifts was similar in all 3 types. On the basis of the patients' scores, all 3 types of units provided appropriate staffing levels necessary to meet the demands for nursing care. Most patients required category III level of care.

CONCLUSION

Need or demand for nursing care in intensive care units in Poland varies according to the type of intensive care unit and can be determined on the basis of scores on the Therapeutic Intervention Scoring System 28.

Development of a nursing workload measurement instrument in burn care

Existing workload measurement instruments fail to represent specific nursing activities in a setting where patients are characterized by a diversity of cause, location, extent and depth of burns, of age and of history. They also do not include educational levels and appropriate time standards. The aim of this study was to develop a reliable measurement instrument for nursing workload in burn care, in order to match quality of patient care with staffing needs. In the first phase, a time study by semi-structured interviews and observations was used to assess direct and indirect care activities. A total of 34 nursing activities were identified, defined, connected to educational levels and attached to time standards. Two independent raters completed a test computer program by assessing performed nursing activities in 36 patients. This yielded intra-class correlations of 0.82, indicating good reliability. In the second phase, a computer program was developed to process quantity and quality of available staff and the sum of time standards of nursing activities per patient per day and to calculate the balance. After 1 year of running this program, the database was used to distinguish patients' care demand into five care categories. This instrument justifies the investment of time by nursing staff needed for daily activities in the burn unit. It provides quick insight into the balance between care demand and staffing needs and can be used to optimise resource planning.

Perioperative nurses' attitudes toward the use of nursing diagnoses in documentation

AIM

This paper reports a study of nurses' attitudes towards the use of nursing diagnoses in perioperative documentation and the factors affecting these attitudes.

BACKGROUND

There are both international and national requests for nurses to move from natural language-based narrative documentation to electronic documentation and clinical use of nursing classifications. However, nurses' attitudes toward nursing classifications have not been widely studied.

METHODS

A questionnaire was distributed to a purposive sample of perioperative nurses (n = 146) who had participated in clinical testing of nursing diagnoses. The response rate was 60% (n = 87). The data were collected in 2003.

RESULTS

In general, nurses' attitudes toward nursing diagnoses were positive. Those over 40 years of age who had clinical experience from 10 to 19 years, postbasic nursing education and previous knowledge of nursing diagnoses were most positive in their attitudes. However, the use of nursing diagnoses in perioperative practice was not seen as either necessary or accurate in describing patients' problems. Furthermore, the documentation of perioperative routines was seen as time-consuming and frustrating.

CONCLUSIONS

Nursing classifications should be included in both preregistration nursing curricula and in-service educational programmes to ensure theoretical knowledge of and practical skills in standardized clinical languages. The perioperative nursing diagnoses should be reviewed to fit better with clinical practice. In addition, current perioperative documentation practices should be reconsidered and updated as appropriate to address clinical requirements better.

Validation of the new Intensive Care Nursing Scoring System (ICNSS)

OBJECTIVES

To validate a new Intensive Care Nursing Scoring System (ICNSS).

DESIGN

Retrospective data collection.

SETTING

Adult 19-bed intensive care unit (ICU) in a tertiary care university hospital.

PATIENTS

A total of 1,538 patient records of which 30 documents were included in the validation.

MEASUREMENTS AND RESULTS

Data included admission scores of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Simplified Acute Physiology Scores II (SAPS II), daily Therapeutic Intervention Scores (TISS) and ICNSS scores. Data were compared using Spearman's correlation, t-test and chi-square test. Receiver operating characteristics (ROC) curve analysis was used to assess the ability of ICNSS and TISS to predict mortality. Intra-class correlation, percentage agreement and kappa statistics were used to test the validity of given scores. Nursing workload assessment using ICNSS showed that medical and emergency-operated patients caused a greater nursing workload than electively operated patients (p<0.001). Six variables of the sub-scale that described vital function nursing accounted for 27.4% of the variation of SAPS II and for 37% of the variation of APACHE II. The ICNSS sub-scale of vital function nursing accounted for a ROC area of 0.91. In the validity of the given ICNSS scores, kappa was 0.81 and weighted kappa 0.82.

CONCLUSIONS

Nursing workload varied between the different admission types. ICNSS explained a similar percentage of the variation of the admission scores of APACHE II and SAPSS II as TISS and discriminated between non-survivors and survivors. ICNSS is a suitable nursing workload instrument to be used with the TISS score.

Removing chest drains - a critical reflection of a complex clinical decision

Decision-making is a fundamental element of nursing work (Boblin-Cummings et al, 1999; Berggren and Severinsson, 2000; Bucknall, 2000) which fluctuates according to experience, location and personal boundaries. Nursing judgements are said to portray the nature of nursing knowledge and practice (Thompson, 1999; Buckingham and Adams, 2000a) and can affect others either favourably or adversely (Gordon et al., 1994), with Buckingham and Adams (2000a) emphasizing the benefits to be gained from understanding the process, including improved clinical effectiveness and self-knowledge. It is said that all decisions are made in one of two ways--hypothetico-deductively or intuitively (Dowie and Elstein, 1988; Thompson, 1999; Buckingham and Adams, 2000a)--although different titles are used interchangeably for the same modes. Both of these modalities are examined. Hypothetico-deductive reasoning entails exposure to information before and during the patient encounter. These data are grouped and used to generate a hypothesis or possible diagnosis. The second stance in decision-making is founded upon intuition and closely associated with expertise. The presence of chest drains after cardiothoracic surgery is known to cause severe pain, thereby interfering with respiratory mechanics and the ability to take part in physiotherapy exercises (Owen and Gould, 1997; Fox et al., 1999; Charnock and Evans, 2001; Lazzara, 2002). This work therefore aims to examine the decision-making processes in relation to the prompt removal of chest drains by analysing the options available and the skills required to utilize them effectively.

Initial validation of the perioperative nursing data set in Finland

PURPOSE

To explore the relevance of the Perioperative Nursing Data Set (PNDS) in Finland.

METHODS

A three-round Delphi technique (10 participants) and content analysis of 134 articles from the Journal of the Finnish Operating Room Nurses Association.

FINDINGS

All the PNDS outcomes, 86% of the diagnoses, and 87% of the interventions were found to be relevant. The Delphi panel suggested, and content analysis revealed, 6 new outcomes, 43 new diagnoses, and 11 new interventions. Consensus was achieved on 77%. The phrases used in perioperative articles corresponded with those of PNDS 56%-78% of the time.

CONCLUSIONS

PNDS can be used to describe perioperative nursing in Finland. Further conceptualization and validation are needed before using the data set in perioperative practice.

IMPLICATIONS FOR PRACTICE

Although PNDS cannot be implemented in Finland as is, it is a valid structure for further development of the terminology, contents, methods, and practice of Finnish perioperative documentation.