Nursing Diagnosis Anyone? Do Staff Nurses Use Nursing Diagnosis Effectively?

Nursing diagnoses, interventions and outcomes ? application and impact on nursing practice: systematic review

AIM

This paper reports a systematic review on the outcomes of nursing diagnostics. Specifically, it examines effects on documentation of assessment quality; frequency, accuracy and completeness of nursing diagnoses; and on coherence between nursing diagnoses, interventions and outcomes.

BACKGROUND

Escalating healthcare costs demand the measurement of nursing's contribution to care. Use of standardized terminologies facilitates this measurement. Although several studies have evaluated nursing diagnosis documentation and their relationship with interventions and outcomes, a systematic review has not been carried out.

METHOD

A Medline, CINAHL, and Cochrane Database search (1982-2004) was conducted and enhanced by the addition of primary source and conference proceeding articles. Inclusion criteria were established and applied. Thirty-six articles were selected and subjected to thematic content analysis; each study was then assessed, and a level of evidence and grades of recommendations assigned.

FINDINGS

Nursing diagnosis use improved the quality of documented patient assessments (n = 14 studies), identification of commonly occurring diagnoses within similar settings (n = 10), and coherence among nursing diagnoses, interventions, and outcomes (n = 8). Four studies employed a continuing education intervention and found statistically significant improvements in the documentation of diagnoses, interventions and outcomes. However, limitations in diagnostic accuracy, reporting of signs/symptoms, and aetiology were also reported (14 studies). One meta-analysis of eight trials including 1497 patients showed no evidence that standardized electronic documentation of nursing diagnosis and related interventions led to better nursing outcomes.

CONCLUSION

Despite variable results, the trend indicated that nursing diagnostics improved assessment documentation, the quality of interventions reported, and outcomes attained. The study reveals deficits in reporting of signs/symptoms and aetiology. Consequently, staff educational measures to enhance diagnostic accuracy are recommended. The relationships among diagnoses, interventions and outcomes require further evaluation. Studies are needed to determine the relationship between the quality of documentation and practice.

Factors associated with nursing diagnosis utilization in Canada

PURPOSE

To investigate factors associated with nursing diagnosis utilization.

METHODS

A retrospective chart audit was conducted on four hospital units over a 5-month period and linked to the nurses (N = 65) who participated in a survey on attitudes toward nursing diagnosis.

FINDINGS

Computer-generated nursing care plans resulted in the greatest frequency of nursing diagnosis documentation. Nurses who did not document nursing diagnoses, and nurses employed in hospitals without nursing diagnosis implementation programs, had more positive attitudes toward the value of nursing diagnosis in practice compared with nurses who documented nursing diagnoses and nurses employed in hospitals with implementation programs.

CONCLUSIONS

Nurses have a greater tendency to document nursing diagnoses when institutions have formal educational programs and computer-generated care plans.

Nursing diagnosis in learning disabilities nursing

The concept of nursing diagnosis and the relevance of individual diagnostic terms from the North American Nursing Diagnosis Association (NANDA) (1992) Classification Taxonomy 1-Revised are discussed in the context of learning disabilities nursing. The NANDA system of nursing diagnoses was implemented at an adult training centre with a client group who had a severe or profound learning disability. The diagnostic terms used to describe the phenomena found in everyday practice are identified. Due to the inadequacy of the NANDA term 'impaired verbal communication', a new nursing diagnosis, 'impaired non-verbal communication', is suggested. A method of recording nursing practice is used which shows client outcomes through diagnostic modifiers (a modifier denotes a change in the nursing diagnosis) over measured time periods. The value of a generic classification of diagnoses is demonstrated in a systematic approach to learning disabilities nursing practice.

The congruence of nursing diagnoses and supporting clinical evidence

In this secondary analysis, 890 patients 40 years of age and older were assessed within 24 hours of transfer from intensive care to medical/surgical units. Nursing diagnoses documented in the hospital record were compared to supporting clinical evidence obtained from subjects, the hospital record, and interviews with subjects and nurse caregivers. The congruence, based on the kappa statistic, between the nursing diagnosis and clinical evidence ranged from 0.1% for altered thought processes to 10% for impaired gas exchange, impaired physical mobility, and potential for injury, while no diagnoses were made for self-care deficits or sensory alterations, visual, when clinical evidence for them was available.

Nursing diagnosis in the North Carolina public health system: a statewide project

A group of North Carolina public health nursing leaders initiated a two-phase process of providing a continuing education module on nursing diagnosis for all public health nurses in the state. In the first phase the authors developed the module to teach the skill of nursing diagnosis and evaluation tools, and statewide workshops were held to teach public health nurse administrators and nurse consultants how to use it with their staffs. Results of the evaluation revealed a significant increase in cognitive learning and a more positive attitude overall toward nursing diagnosis among 148 participants. Written comments revealed two major concerns for using nursing diagnoses: the need for additional practice, and charting issues. Both were addressed in this project. Phase two, in which administrative nurses are using the module to teach nursing diagnoses to their staffs, is under way.