Frequency of Respiratory Nursing Diagnoses and Accuracy of Clinical Indicators in Preterm Infants

Analysis of the causal factors of the nursing diagnosis of ineffective breathing pattern in children with congenital heart disease

PURPOSE

To analyze the causal factors of the nursing diagnosis of ineffective breathing pattern (IBP) in children with congenital heart disease.

METHODS

This was a cross-sectional study carried out in a tertiary hospital located in northeastern Brazil. Our sample was composed of 340 children with congenital heart disease. The latent class model with adjusted random effects determined the IBP. Univariate logistic regression analysis was performed for each IBP nursing diagnosis causal factor.

RESULTS

The analysis of etiological factors for the nursing diagnosis of IBP in children with congenital heart disease revealed a high prevalence of all causal factors investigated. The causal factors with the greatest impact on the occurrence of IBP were body position that inhibits pulmonary expansion; physical effort; pain; age less than two years; increased resistance to air passages; and reduced pulmonary compliance.

CONCLUSIONS

The occurrence of causal factors, body position that inhibits pulmonary expansion, physical effort, pain and age less than two years increases the chance of IBP nursing diagnosis in children with congenital heart disease.

IMPLICATIONS TO PRACTICE

The results obtained in this investigation can guide pediatric nurses in making diagnostic decisions, as identifying the causal factors that trigger or potentiate IBP in children with congenital heart disease allows nurses to intervene early, facilitating the maintenance of breathing patterns.

The quality of nursing documentation and standardized nursing diagnoses in the children's hospital electronic nursing records

AIM

The aim of the paper is to compare the quality of nursing documentation in the Children's Hospital before and after the NANDA-I nursing diagnoses training.

METHODS

Research employed the interventional study design, and pre-post study design. Before and after the NANDA-I nursing diagnoses training, 50 nursing records were analyzed in the interventional pre-post study, using D-Catch instrument.

RESULTS

The most often documented problem-centered nursing diagnosis before training was anxiety and after the training, hyperthermia. The most common risk diagnoses before and after the training was risk of infection. Before the training, one health promotion diagnosis was determined in the nursing records, and after the training the number increased to four. The highest value was given to readability of the nursing documentation both before and after the training. The lowest score before the training was given to the quality determiners of the accurate nursing diagnoses and after the training given to the determiners of the results' quantity. The sum score of documenting the nursing interventions was the most inconsistent before the training and after the training. The most consistent was the readability of the nursing records before and after the training. Statistically significant differences in the improvement of quality were revealed in all areas except for the readability of the nursing documentation and the quantity of nursing assessment.

CONCLUSIONS

The results of the study revealed that following the training, the quality of nursing documentation improved, the wording of the nursing diagnoses improved, and the number of accurate nursing diagnoses had increased.

IMPLICATIONS FOR NURSING PRACTICE

Results of the research provide an overview of the importance of the training in improving the quality of nursing documentation and aid the educators in planning the trainings, focusing more on the challenges in the documentation.

Teoria de Médio Alcance do Padrão Respiratório Ineficaz em Crianças com Cardiopatia Congênita

Resumo Objetivo: desenvolver e avaliar uma teoria de médio alcance para o Diagnóstico de Enfermagem de Padrão Respiratório Ineficaz em crianças com cardiopatia congênita. Método: um estudo metodológico realizado em duas etapas: 1) desenvolvimento de uma teoria de médio alcance para padrão respiratório ineficaz em crianças com doenças cardíacas congênitas a partir da análise da taxonomia NANDA-Internacional, modelo de adaptação de Callista Roy e uma revisão da literatura; e 2) avaliação da teoria de médio alcance desenvolvida por meio da avaliação de painéis de especialistas. Resultados: após três avaliações de painéis, a versão final da teoria de médio alcance resultou em quatro metaparadigmas, dois conceitos-chave, dois diagramas pictóricos, duas propostas e uma descrição das inter-relações entre os conceitos-chave do Padrão Respiratório Ineficaz em crianças com cardiopatias congênitas e evidências para a prática de Enfermagem. Conclusão: a teoria do médio alcance desenvolvida e avaliada por especialistas identificou estímulos e comportamentos que podem auxiliar os enfermeiros na identificação das razões pelas quais o Padrão Respiratório Ineficaz é diagnosticado e como ele se manifesta em crianças com cardiopatia congênita, aumentando a compreensão das relações entre as causas e sua temporalidade.

Middle-Range Theory of Ineffective Breathing Pattern in children with Congenital Heart Disease

OBJECTIVE

to develop and evaluate a middle-range theory for the Nursing Diagnosis of Ineffective Breathing Pattern in children with congenital heart disease.

METHOD

a methodological study carried out in two stages: 1) development of a middle- range theory for Ineffective Breathing Pattern in children with congenital heart diseases from the analysis of the NANDA-International taxonomy, Callista Roy's Adaptation Model and a literature review; and 2) assessment of the middle-range theory developed using expert panel evaluation.

RESULTS

after three panel evaluations, the final version of the middle-range theory resulted in four metaparadigms, two key concepts, two pictorial diagrams, two propositions and a description of the interrelationships between the key concepts of Ineffective Breathing Pattern in children with congenital heart diseases and evidence for the Nursing practice.

CONCLUSION

the middle-range theory developed and evaluated by experts identified stimuli and behaviors that can assist nurses in identifying the reasons why Ineffective Breathing Pattern is diagnosed and how it manifests itself in children with congenital heart disease, increasing understanding of the relationships between the causes and their temporality.

Teoría de Mediano Alcance del Patrón de Respiración Ineficiente en niños con cardiopatías congénitas

Resumen Objetivo: desarrollar y evaluar una teoría de mediano alcance para el Diagnóstico de Enfermería “Patrón de Respiración Ineficiente” en niños con cardiopatías congénitas. Método: estudio metodológico desarrollado en dos etapas: 1) Desarrollo de una teoría de mediano alcance para el Patrón de Respiración Ineficiente en niños con cardiopatías congénitas a partir del análisis de la taxonomía NANDA-Internacional, del Modelo de Adaptación de Callista Roy y de una revisión de la literatura; y 2) Evaluación de la teoría de mediano alcance desarrollada por medio de una evaluación de un panel de expertos. Resultados: después de tres evaluaciones a cargo del panel, la versión final de la teoría de mediano alcance derivó en cuatro metaparadigmas, dos conceptos clave, dos pictogramas, dos propuestas y una descripción de las interrelaciones entre los conceptos clave del Patrón de Respiración Ineficiente en niños con cardiopatías congénitas y evidencia para la práctica de Enfermería. Conclusión: la teoría de mediano alcance desarrollada y evaluada por expertos identificó estímulos y comportamientos que pueden ayudar a los enfermeros a identificar los motivos por los cuales se diagnostica el Patrón de Respiración Ineficiente y cómo se manifiesta en niños con cardiopatías congénitas, mejorando así la comprensión de las relaciones entre las causas y su temporalidad.

International Collaboration and New Research Evidence on Nanda International Terminology

OBJECTIVES

To discuss priorities and possibilities for promoting international collaboration and new research evidence on NANDA International, Inc. (NANDA-I).

METHODS

Theoretical reflection article based on the literature and the authors' opinions on the subject matter, carried out by six research nurses.

CONCLUSIONS

International research collaboration for NANDA-I allows the improvement of research production in an actual clinical setting, especially with multicenter and validation studies, conducted by researchers from different countries. This provides for improved understanding of patients' experiences and may help to produce robust scientific evidence.

IMPLICATIONS FOR NURSING KNOWLEDGE

The generation of new evidence may lead to an increase in NANDA-I visibility and in nurses' understanding of its meaning for clinical practice and for the formulation of diagnostic hypotheses.

Accuracy of Defining Characteristics for Nursing Diagnoses Related to Patients with Respiratory Deterioration

PURPOSE

To evaluate accuracy of defining characteristics (DCs) for impaired gas exchange (IGE), impaired spontaneous ventilation (ISV), and ineffective breathing pattern (IBP) in respiratory deterioration.

METHODS

This study is a retrospective analysis of medical records. The accuracy and predictive ability of DC or of clusters are calculated.

FINDINGS

In this study, 391 records were evaluated. For IGE, DCs or clusters with higher efficiency were "hypercapnia" (78%), "somnolence" (74.4%), and "hypercapnia + tachycardia" (88%); for ISV, the cluster with higher efficiency was "increased heart rate ± decrease in cooperation" (70.1%); and for IBP, no DC or cluster exceeded 70% efficiency. These were confirmed by logistic regression.

CONCLUSION

Few DCs had adequate efficiency for respiratory nursing diagnoses, while in some cases clusters accounted for higher efficiency.

IMPLICATIONS FOR NURSING PRACTICE

Clusters of DC may be relevant for respiratory diagnoses.