Clinical indicators of nursing outcomes classification for patient with risk for perioperative positioning injury: A cohort study

Abstract

Aims and objectives To test the validity and reliability of Nursing Outcomes Classification outcomes and their clinical indicators for patients with the nursing diagnosis ‘Risk for perioperative positioning injury’. Background Surgical positioning is an essential part of perioperative nursing practice. The use of a standardised language values the clinical evaluation of the perioperative nurse, reinforcing its contribution to surgical patient care. Design Longitudinal concept validation cohort study. Methods Patients were selected based on the operating room surgical schedule. The sample included adult patients who underwent elective surgical procedures requiring anaesthesia, classified as surgical class 2, 3 or 4. Outcomes were measured with an instrument, which included 33 clinical indicators for eight outcomes. The patients were assessed at five distinct time points in the perioperative phases. This study followed the STROBE guidelines. Results A total of 50 patients were included. Each underwent five clinical assessments, for a total of 250 documented assessments. Differences in evaluations were mostly related to reduced scores of clinical indicators in the immediate postsurgical time points, which recovered to the highest score at the end of the fifth (and last) evaluation. The results of factor analysis and Cronbach's alpha calculations suggested a new configuration for this nursing outcomes, consisting of five outcomes—Circulation Status, Tissue Perfusion: peripheral, Neurological Status: peripheral, Tissue Integrity: skin and mucous membranes and Thermoregulation—and 13 clinical indicators. Conclusions Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnosis at ‘Risk for perioperative positioning injury’ are sensitive to patient states during the perioperative period. Relevance to clinical practice Use of nursing taxonomies during the perioperative period may contribute to the discussion on the role of perioperative nurses and their relevance in patient care.

Clinical applicability of Nursing Outcomes related to breastfeeding establishment in the Neonatal Intensive Care Unit

“…A análise do risco relativo a partir de um modelo de análise ao longo do tempo foi escolhida para verificar o comportamento das pontuações da escala Likert (17) . A partir dessa análise, a NOC demonstrou ser uma importante ferramenta para mensurar a mudança clínica ao longo do tempo em diversos cenários, com a capacidade de ser adaptada de acordo com as intervenções de enfermagem realizadas (27)(28)(29)(30) .…”

Knowledge translation for nursing care for patients with Risk of perioperative positioning injury: A case report

“…The study on the clinical applicability of the NOC for diagnosing the Risk of perioperative positioning injury (00087) showed that teams rely on nursing care to prevent injuries from surgical positioning with a frequency above 80% for eight of the 14 interventions registered in the electronic system analyzed (Bjorklund- Lima et al, 2019). Documenting care via nurse practices is one of the stages of the nursing process that grants visibility to their work and contains substantial elements for evaluating care outcomes (Beyea, 2000;Bjorklund-Lima et al, 2019;Junttila et al, 2005). The review of the procedures in the electronic system of the chosen hospital provided nurses and nursing teams with better work quality and planning of preventive interventions in surgical positioning.…”

“…Other events such as compartment syndrome, eye injuries and pain related to surgical positioning are also documented in the literature (Addley et al, 2021;Ginsburg et al, 2018;Singh et al, 2021). Thus, care staff requires training, which is based on the newest evidence reported in clinical studies to correctly position surgical patients and prevent accidental and irreversible injuries (Bjorklund-Lima et al, 2019;Burlingame, 2017;Woodfin et al, 2018). Moreover, due to the evolution of technology and new practices constantly improving surgical positioning techniques, updated guidelines must serve as the basis for educational programs and protocols (Burlingame, 2017;Spruce & Wicklin, 2014;Woodfin et al, 2018).…”

“…In a study conducted in the surgical center of a public university hospital in Brazil, the validity, reliability and applicability of the Nursing Outcomes Classification (NOC) (Moorhead et al, 2018) and their clinical indicators for patients diagnosed with 'Risk of perioperative positioning injury' (00087) were evaluated (Bjorklund-Lima et al, 2019;Herdman et al, 2021;Lima et al, 2019). The results showed that the NOC presents relevant and viable indicators which are applicable in, and relevant for clinical practice (Bjorklund-Lima et al, 2019). Knowledge translation is relevant to put the best available evidence found in health systems into practice and to aid nurses in decisionmaking (Chapman et al, 2020;Ferraz et al, 2019;Lucena et al, 2021).…”

Validações de conceitos da classificação internacional para a prática de enfermagem: revisão integrativa

“…A validação deve ser compreendida como uma importante contribuição para os profissionais da área, dada a importância de subsidiar o processo do cuidado com informações seguras e acuradas. Trata-se de um processo gradual de análise, que pode envolver a análise de conceito (Andrade et al, 2017), que incorpora uma avaliação dos elementos básicos que compõem um pensamento, ideia ou noção (Burnell, 2009); a validação de conteúdo (Lynn, 1986;Abreu-Figueiredo et al, 2019), que representa o universo do conteúdo ou do domínio de dado construto e fornece a estrutura para a formulação de questões que representarão adequadamente o conteúdo (Lobiondo-Wood et al, 2001;Polit et al, 2011); e a validação clínica, pela qual são identificados indicadores clínicos em pacientes (Silva et al, 2019;Bjorklund-Lima et al, 2019). Em algumas tipologias, é requerida a participação de especialistas (Fehring, 1987;Chaves et al, 2008;Nóbrega et al, 2015) com conhecimento e habilidades de pesquisador ou com experiência clínica (Galdeano et al, 2006).…”