SESSION 6.

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MOST FREQUENT NURSING DIAGNOSES AND INTERVENTIONS IDENTIFIED IN A BRAZILIAN INTENSIVE CARE UNIT
Lucena, AF – PhD in Science Barros, ALB – PhD in Science Ganzarolli, MZ – MS Student in Science Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Universidade Federal de São Paulo Brazil

Porto Alegre → Rio Grande do Sul Brazil

INTRODUCTION
• Nursing Process has been used for over 30 years at HC • In 2000, the stages of nursing diagnosis and nursing care prescription were computerized • NANDA was one of the references used, NIC was not • The need to know more about the clinical practice was a motivation to carry out Research:


Nursing diagnoses Nursing interventions

• The first part of the resuts’s research about the nursing diagnoses was published • The second part ⇒ nursing interventions • 97.2% of the nursing care actions prescribed in the ICU/HC were similar to the ones describe in NIC

Describing Use of Nursing Interventions for Three Groups of Patients

Journal of Nursing Scholarship Volume 37 Issue 1, Pages 57 - 66 Published Online: 10 Feb 2005

Dochterman et al.

• The knowledge of nursing interventions used in clinical practice has major implications for: • staff development • nursing education • making staffing decisions for different patients

PURPOSE
• To identify the nursing interventions established in the daily clinical practice of an Intensive Care Unit (ICU) for the most common nursing diagnoses

METHODS
• Descriptive cross-sectional study • ICU of a University Hospital ⇒ Porto Alegre Brazil

HOSPITAL DE CLÍNICAS DE PORTO ALEGRE - HC

• • • • •

Public, general and university hospital 60 different specialties 800 beds Offers highly qualified professional training Develops research in several health areas

METHODS
SAMPLE
• 991 patients admitted to the ICU during a 6 month period
DATA COLLECTION

• retrospective, in the hospital’s electronic data-base

ANALYSES
• descriptive statistical methods • cross-mapping between each nursing care action prescribed and the NIC interventions
(Moorhead & Delaney, 1997)

FINDINGS AND DISCUSSION
Most Common Nursing Diagnoses • Bathing/Hygiene self-care deficit • Risk for infection • Impaired physical mobility • Ineffective breathing pattern • Impaired spontaneous ventilation • Risk for impaired skin integrity % 98.1 95.9 59.3 49.8 43.1 40.7

FINDINGS AND DISCUSSION
• 19.490 nursing care actions were prescribed

• 212 different types of one • 119 nursing interventions (NIC) were mapped • 57 different nursing interventions (NIC) ⇒ after repeated items were excluded
* Some of the nursing care actions prescribed, as well as the mapped interventions (NIC), have been described for more than one single nursing diagnosis

FINDINGS AND DISCUSSION
Nursing diagnosis
Different interventions NIC

Interventions level - NIC
Priority Suggested Additional Not Optional linked diagnosis

Bathing/Hygiene selfcare deficit Risk for infection Impaired physical mobility Ineffective breathing pattern Impaired spontaneous ventilation Risk for impaired skin integrity Total

18 28 17 25 17 14 119

2 2 1 2 4 3 14

3 4 4 6 8 2 27

3 7 3 8 1 4 26

10 15 9 9 4 5 52

NIC interventions ⇒ Bathing/Hygiene Self-Care Deficit
Intervention’s level as linked NIC/NANDA Different nursing care actions prescribed in the ICU

%

Self-care assistance: bathing/hygiene Bathing Hair care Períneal care Oral health maintenance Self-care assistance Emotional Support Positioning Self-care assistance: toileting Pain management Bed rest care Urinary retention care Teaching: disease process Teaching: procedure/treatment Vital signs monitoring Anticipatory guidance Surveillance Famíly support
TOTAL

Priority

19

55.9

Suggested

4

11.8

Additional Optional Not linked

4

11.8

7

20.5

18

34

100

NIC interventions ⇒ Risk for Infection
Intervention’s level as linked NIC/NANDA * Infection control Infection protection
Bathing Wound care Skin surveillance Fluid/electrolyte management

Different nursing care actions prescribed in the ICU 12 7

% 25.5 14.9

Priority Suggest

Incision site care Tube care Tube care: gastrointestinal Tube care: chest Tube care: urinary Teaching: disease process Vital signs monitoring
Medication administration Total parenteral nutrition Self-care assistance Security enhancement Artificial airway management Ostomy care Urinary incontinence care Urinary retention care Teaching: procedure/treatment Intravenous insertion Anticipatory guidance Anxiety reduction Emotional Support Famíly support Intravenous therapy

Additional Optional

14

29.8

Not Linked

11

23.4

TOTAL

28

44

93.6

NIC interventions ⇒ Impaired Physical Mobility
Intervention’s level as linked NIC/NANDA * Positioning Environmental management Bed rest care Positioning : wheelchair Exercise therapy: ambulation Pain management Neurológic monitoring Skin surveillance Enviromental management: confort Teaching: disease process Teaching: procedure/treatment Vital signs monitoring Anticipatory guidance Pressure ulcer prevention Anxiety reduction Famíly support Emotional Support TOTAL Priority Suggest Different nursing care actions prescribed in the ICU 16 9

%

43.2 24.3

Additional Optional Not Linked

5

13.6

16.2 6

17

36

97.3

NIC interventions ⇒ Ineffective Breathing Pattern
Intervention’s level as linked NIC/NANDA * Airway management Respiratory monitoring Ventilation assistance Vital signs monitoring Oxygen therapy Anxiety reduction Surveillance Mechanical ventilation Airway suctioning Pain managemen Artificial airway management Tube care: chest Chest phisiotherapy Neurologic monitoring Positioning Emotional Support
Infection control Enviromental management: confort Bed rest care Eye care Tube care: gastrointestinal Teaching: procedure/treatment Teaching: disease process Anticipatory guidance Famíly support

Different nursing care actions prescribed in the ICU

%

Priority Suggest

12 12

24.5 24.5

Additional Optional

15

30.6

Not Linked

8

16.3

TOTAL

25

47

96

NIC interventions ⇒ Impaired Spontaneous Ventilation
Intervention’s level as linked NIC/NANDA Ventilation assistance Artificial airway management Respiratory monitoring Mechanical ventilation Airway suctioning Infection control * Airway management Mechanical ventilatory weaning Chest phisiotherapy Vital signs monitoring Oxygen therapy Positioning Tube care: gastrointestinal Teaching: procedure/treatment Teaching: disease process Anticipatory guidance Famíly support TOTAL Priority Different nursing care actions prescribed in the ICU 10 % 41.7

Suggest

9

37.5

Additional Optional No Linked

2 3

8.3 12.5

17

24

100

NIC interventions ⇒ Risk for Impaired Skin Integrity
Intervention’s level as linked NIC/NANDA Pressure management * Pressure ulcer prevention Skin surveillance Positioning Wound care Bathing Perineal care Bed rest care Vital signs monitoring Medication administration Medication administration: subcutaneous Hyperglycemia management Urinary elimination management Pressure ulcer care TOTAL 14 21 100 Priority Different nursing care actions prescribed in the ICU 15 %

71.4

Suggest Additional Optional

4 1

19 4.8

Not Linked

1

4.8

CONCLUSIONS
• 57 different nursing interventions were identified and the most frequently found were:

Physiological Basic Domain
Self-care assistance: bathing / hygiene Bathing Bed rest care Positioning Positioning : wheelchair Exercise therapy: ambulation Tube care Tube care: urinary Tube care: gastrointestinal Pain management

CONCLUSIONS
• Physiological complex domain
Airway management Respiratory monitoring Ventilation assistance Oxygen therapy Mechanical ventilation Airway suctioning Artificial airway management Chest phisiotherapy Incision site care Tube care: chest Ventilation assistance Artificial airway management Mechanical ventilatory weaning Neurologic monitoring Pressure management Pressure ulcer prevention Skin surveillance

CONCLUSIONS
• Safety Domain
Infection control Infection protection Vital signs monitoring Surveillance Environmental management

• Behavioral Domain
Anxiety reduction Emotional Support Teaching: disease process

CONCLUSIONS
• Most nursing interventions found in the ICU were: • • • physiological complex domains physiological basics domains priority and suggested levels links NIC / NANDA

• The group of nursing diagnoses and interventions identified can be used: • refinement of care plans • implement electronic information systems

Thank you !!