PURPOSE
To analyze actual patient data recorded by nurses within a computerized documentation system using standardized NANDA, NIC, and NOC nursing language in order to validate the linkages of diagnoses, interventions, and outcomes; identify the important variables for risk adjustment; and verify which nursing interventions assist patients to achieve their desired outcomes for patients with pneumonia, congestive heart failure (CHF), and total joint replacement (TJR).
METHODS
This was a descriptive exploratory study. The study sample consisted of all records of patients admitted with pneumonia, CHF, or TJR. A total of 566 patient records were collected for analysis. The most frequent nursing diagnoses, interventions, and outcomes were identified for each of the populations. Linkages among nursing diagnoses, interventions, and outcomes from the study data were compared with published linkage work.
FINDINGS
The average number of nursing diagnoses for patients admitted with pneumonia was 9.5 (SD± 3.0), patients with CHF averaged 10.1 (SD± 2.70), and patients with TJR averaged 10.4 (SD± 2.07). Nursing diagnoses common across all three populations were knowledge deficit, ineffective airway clearance, decreased cardiac output, pain, impaired physical mobility, altered urinary elimination, risk for impaired or impaired skin integrity, and altered nutrition: less than body requirements. The average number of interventions for each patient population was pneumonia 18.3 (SD± 7.74), CHF 19.3 (SD± 7.02), and TJR 20.5 (SD± 4.28). Interventions common across all three populations were “teaching: individual,”“discharge planning,”“family involvement,”“respiratory monitoring,”“ventilation assistance,”“cardiac care,”“self‐care assistance,”“urinary elimination management,” and “gastrointestinal surveillance.” The number of outcomes for patients with pneumonia, CHF, and TJR, respectively, averaged 9.01 (SD± 3.58), 9.71 (SD± 3.0), and 9.58 (SD± 1.80). Outcomes common across the three populations were Knowledge: Illness Care, Respiratory Status: Ventilation, Cardiac Pump Effectiveness, Mobility Level, Urinary Elimination, and Nutritional Status. Results of the comparisons among nursing diagnoses, outcomes, and interventions from the study data and previously published works indicated that, for the three populations combined, 71%–85% of the interventions were classified as major, suggested, or optional.
The effect of nursing interventions on patient outcomes was evaluated using repeated measures MANCOVA controlling for the variables of age, gender, acuity, and comorbid conditions. The five most frequent outcomes for each patient population were studied. Nursing interventions that were statistically significant or indicated a positive effect for patients in the pneumonia population were “oxygen therapy” and “family involvement.” Statistically significant nursing interventions for patients with CHF were “oxygen therapy,”“anxiety reduction,” and “gastrointestinal surveillance.” The interventions of “multidisciplinary care conference,”“ort...