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MOST FREQUENT NURSING

DIAGNOSES AND INTERVENTIONSIDENTIFIED IN A BRAZILIAN

INTENSIVE CARE UNIT

Lucena, AF PhD in ScienceBarros, ALB PhD in ScienceGanzarolli, MZ MS Student in Science

Hospital de Clnicas de Porto AlegreUniversidade Federal do Rio Grande do Sul BrazilUniversidade Federal de So Paulo

SESSION 6.8

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Porto AlegreRio Grande do Sul

Brazil

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INTRODUCTION Nursing Process has been used for over 30 years at HC In 2000, the stages of nursing diagnosis and nursingcare 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

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The first part of the resutss research about thenursing diagnoses was published

The second part nursing interventions 97.2% of the nursing care actions prescribed in theICU/HC were similar to the ones describe in NIC

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The knowledge of nursing interventions used inclinical practice has majorimplications for:

staff development

nursing education

making staffing decisions for different patients

Describing Use of Nursing Interventions forThree Groups of Patients

Dochterman et al.Journal of Nursing ScholarshipVolume 37 Issue 1, Pages 57 - 66Published Online: 10 Feb 2005

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To identify the nursing interventions

established in the daily clinical practice of an

Intensive Care Unit (ICU) for the most

common nursing diagnoses

PURPOSE

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Descriptive cross-sectional study

ICU of a University Hospital Porto AlegreBrazil

METHODS

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HOSPITAL DE CLNICAS 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

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SAMPLE

991 patients admitted to the ICU during a 6month period

DATA COLLECTION

retrospective, in the hospitals electronicdata-base

ANALYSES

descriptive statistical methods

cross-mapping between each nursing care

action prescribed and the NIC interventions(Moorhead & Delaney, 1997)

METHODS

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FINDINGS AND DISCUSSION Bathing/Hygiene self-care deficit

Risk for infection Impaired physical mobility

Ineffective breathing pattern Impaired spontaneous ventilation

Risk for impaired skin integrity

98.1

95.959.3

49.843.1

40.7

Most Common Nursing Diagnoses %

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19.490 nursing care actions were prescribed

212 different types of one

119 nursing interventions (NIC) were mapped

57 different nursing interventions (NIC) afterrepeated 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

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FINDINGS AND DISCUSSIONNursing diagnosis Different

interventionsNIC

Interventions level - NIC

Priority SuggestedAdditionalOptional

Notlinkeddiagnosis

Bathing/Hygiene self-care deficit

18 2 3 3 10

Risk for infection 28 2 4 7 15

Impaired physicalmobility

17 1 4 3 9

Ineffective breathingpattern

25 2 6 8 9

Impaired spontaneousventilation

17 4 8 1 4

Risk for impaired skinintegrity

14 3 2 4 5

Total 119 14 27 26 52

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NIC interventions Bathing/Hygiene Self-Care DeficitInterventions

level as linkedNIC/NANDA

Different nursing care

actions prescribed inthe ICU

%

Self-care assistance: bathing/hygiene Priority 19 55.9Bathing

Hair care Suggested 4 11.8Perneal careOral health maintenance

Self-care assistance Additional

Optional

4 11.8Emotional Support

Positioning

Self-care assistance: toileting Not linked 7 20.5Pain managementBed rest care

Urinary retention careTeaching: disease processTeaching: procedure/treatment

Vital signs monitoringAnticipatory guidance

SurveillanceFamly support

TOTAL 18 34 100

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NIC interventions Risk for InfectionInterventions level as

linked NIC/NANDADifferent nursing care actions

prescribed in the ICU%

* Infection controlPriority 12 25.5Infection protection

BathingSuggest 7 14.9Wound care

Skin surveillanceFluid/electrolyte management

Incision site careAdditional

Optional

14 29.8Tube careTube care: gastrointestinalTube care: chestTube care: urinary

Teaching: disease processVital signs monitoring

Medication administrationNot Linked 11 23.4Total parenteral nutrition

Self-care assistanceSecurity enhancementArtificial airway management

Ostomy careUrinary incontinence careUrinary retention careTeaching: procedure/treatmentIntravenous insertionAnticipatory guidanceAnxiety reduction

Emotional SupportFamly supportIntravenous therapy

TOTAL 28 44 93.6

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NIC interventions Impaired Physical MobilityInterventions level as

linked NIC/NANDA

Different nursing care

actions prescribed in the ICU

%

* Positioning Priority 16 43.2

Environmental managementSuggest

9 24.3Bed rest care

Positioning : wheelchair

Exercise therapy: ambulation

Pain management Additional

Optional

5 13.6Neurolgic monitoring

Skin surveillance

Enviromental management: confort Not Linked

6

16.2Teaching: disease process

Teaching: procedure/treatment

Vital signs monitoringAnticipatory guidance

Pressure ulcerprevention

Anxiety reduction

Famly support

Emotional Support

TOTAL 17 36 97.3

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NIC interventions Ineffective Breathing PatternInterventions level as

linked NIC/NANDADifferent nursing care

actions prescribed in the

ICU

%

* Airway managementPriority 12 24.5

Respiratory monitoringVentilation assistance

Suggest 12 24.5Vital signs monitoringOxygen therapy

Anxiety reductionSurveillanceMechanical ventilationAirway suctioning

AdditionalOptional

15 30.6Pain managemenArtificial airway managementTube care: chestChest phisiotherapyNeurologic monitoringPositioningEmotional Support

Infection control Not Linked 8 16.3Enviromental management: confortBed rest care

Eye care

Tube care: gastrointestinal

Teaching: procedure/treatment

Teaching: disease process

Anticipatory guidance

Famly support

TOTAL 25 47 96

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NIC interventions Impaired Spontaneous VentilationInterventions level as

linked NIC/NANDADifferent nursing care

actions prescribed in the

ICU

%

Ventilation assistance Priority 10 41.7

Artificial airway management

Respiratory monitoring

Mechanical ventilation

Airway suctioningSuggest

9 37.5

Infection control

* Airway management

Mechanical ventilatory weaning

Chest phisiotherapy

Vital signs monitoring

Oxygen therapy

Positioning

Tube care: gastrointestinal Additional Optional 2 8.3

Teaching: procedure/treatment No Linked 3 12.5

Teaching: disease process

Anticipatory guidance

Famly support

TOTAL 17 24 100

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NIC interventions Risk for Impaired Skin IntegrityInterventions level

as linkedNIC/NANDA

Different nursing

care actionsprescribed in the ICU

%

Pressure management Priority 15 71.4

* Pressure ulcer prevention

Skin surveillancePositioning Suggest 4 19

Wound care

Bathing Additional

Optional

1 4.8

Perineal care

Bed rest care

Vital signs monitoring

Medication administration Not Linked 1 4.8

Medication administration:subcutaneous

Hyperglycemia management

Urinary elimination management

Pressure ulcer careTOTAL 14 21 100

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57 different nursing interventions were identified and themost frequently found were:

CONCLUSIONS

Physiological Basic DomainSelf-care assistance: bathing / hygieneBathingBed rest carePositioningPositioning : wheelchairExercise therapy: ambulationTube careTube care: urinaryTube care: gastrointestinalPain management

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Physiological complex domainCONCLUSIONS

Airway managementRespiratory monitoringVentilation assistanceOxygen therapyMechanical ventilationAirway suctioningArtificial airway managementChest phisiotherapyIncision site care

Tube care: chestVentilation assistanceArtificial airway managementMechanical ventilatory weaningNeurologic monitoringPressure managementPressure ulcer preventionSkin surveillance

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Safety DomainCONCLUSIONS

Infection controlInfection protectionVital signs monitoringSurveillanceEnvironmental management

Behavioral DomainAnxiety reductionEmotional SupportTeaching: disease process

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Most nursing interventions found in the ICU were:

physiological complex domains physiological basics domains priority and suggested levels links NIC / NANDA

CONCLUSIONS

The group of nursing diagnoses and interventions

identified can be used:

refinement ofcare plans implement electronic information systems

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Thank you !!