Most Frequent Nursing Diagnoses,Nursing Interventions,and Nursing-Sensitive Patient Outcomes of Hospitalized Older Adults With Heart Failure: Part 1

Abstract

Purpose. Rank and compare the 10 most frequently documented nursing diagnoses, interventions, and patient outcomes using NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification for care of patients with heart failure (HF).

Methods. A descriptive comparative multisite study of documented care for 302 older adults with HF.

Findings. There were four common nursing diagnoses, two interventions, and only three common outcomes across three sites.

Conclusions. This and similar analyses of clinical nursing data can be used by nursing administrators and clinicians to monitor the quality and effectiveness of nursing care.

Implications. Similar analyses may be used for continuing education, quality improvement, and documentation system refinement. Part 2 will discuss data retrieval and implications for building a multiorganizational data warehouse.

Keywords

Nursing classification systems clinical information systems comparative effectiveness research

Get full access to this article

View all access options for this article.

References

Arnold

J. M. O.

Howlett

J. G.

Ducharme

Ezekowitz

J. A.

Gardner

M. J.

Giannetti

, . . . White

(2008). Canadian Cardiovascular Society consensus conference guidelines on heart failure—2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies. Canadian Journal of Cardiology, 24(1), 21–40.

Assis

C. C.

Barros

A. B. L.

(2003). Nursing diagnoses in patients with congestive heart failure. International Journal of Nursing Terminologies & Classifications, 14(Suppl.4), 1. doi: 10.1111/j.1744-618X. 2003.001-1.x.

Bulechek

G. M.

Butcher

H. K.

Dochterman

J. M.

(2008). Nursing Interventions Classification (NIC) (5th ed.). St. Louis, MO: Mosby Elsevier.

Dickstein

Cohen-Solal

Filippatos

McMurray

J. J. M.

Ponikowski

Poole-Wilson

P. A.

, . . . Hasin

(2008). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. European Heart Journal, 29, 2388–2442. doi: 10.1093/eurheartj/ehn309

eHealth Initiative . (2009). What is comparative effectiveness? Retrieved April 16, 2010 from http://www.ehealthinitiative.org/what-comparative-effectiveness.html

Gardetto

N. J.

Carroll

K. C.

(2007). Management strategies to meet the core heart failure measures for acute decompensated heart failure: A nursing perspective. Critical Care Nursing Quality, 30(4), 307–320. doi: 10.1097/01

Gies

C. E.

Buchman

Robinson

Smolen

(2008). Effect of an inpatient nurse-directed smoking cessation program. Western Journal of Nursing Research, 10(1), 6–19. doi: 10.1177/0193945907302729

Harrison

M. B.

Graham

I. D.

Logan

Toman

Friederg

(2007). Evidence to practice: Pre-post implementation study of a patient/provider resource for self-management with heart failure. International Journal of Evidence-Based Healthcare, 5, 92–101. doi: 10.1111/j.1479-6988.2007.00057.x

Head

B. J.

(2005). Nursing outcomes effectiveness: Hospitalized elders with pneumonia and heart failure. Grant application funded by the Gerontological Nursing Interventions Research Center and the Hartford Center for Geriatric Nursing Excellence, The John A. Hartford Foundation, University of Iowa College of Nursing.

10.

Hunt

S. A.

Abraham

W. T.

Chin

M. H.

Feldman

A. M.

Francis

G. S.

Ganiats

T. G.

, . . . Yancy

C. W.

(2005). ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. Circulation, 112, e154–e235. doi: 10.1161/CIRCULATIONAHA.105.167586

11.

Institute of Medicine . (2009). Initial priorities for comparative effectiveness research. Retrieved November 24, 2009 from http://www.iom.edu/∼/media/Files/Report%20Files/2009/ComparativeEffectivenessResearchPriorities/CER%20report%20brief%2008-13-09.ashx

12.

Jaarsma

Halfens

Tan

Abu-Saad

H. H.

Dracup

Diederiks

(2000). Self-care and quality of life in patients with advanced heart failure: The effect of a supportive educational intervention. Heart & Lung, 29(5), 319–330. doi: 10.1067/mhl.2000.108323.

13.

Johnson

Bulechek

Dochterman

J. M.

Maas

Moorhead

(2001). Nursing diagnoses, outcomes, & interventions: NANDA, NOC, and NIC linkages. St. Louis, MO: Mosby.

14.

Lee

Mamdani

Austin

Gong

Liu

Rouleau

J. V.

(2004). Trends in heart failure outcomes and pharmacotherapy: 1992 to 2000. American Journal of Medicine, 116(9), 581–589. doi: 10.1016/j.amjmed.2003.11.025

15.

Moorhead

Johnson

Maas

M. L.

Swanson

(2008). Nursing Outcomes Classification (NOC) (4th ed.). St. Louis, MO: Mosby Elsevier.

16.

Mushlin

A. I.

Ghomrawi

(2010). Health care reform and the need for comparative effectiveness research. New England Journal of Medicine, 362(3), e6(1)–e6(3). PMID: 20054035.

17.

NANDA-I . (2008). Nursing diagnoses, 2009–11 edition: Definitions and classification. Philadelphia: Author.

18.

National Guideline Clearinghouse . (2009). NGC search results: Heart failure. Retrieved March 7, 2009 from http://www.guideline.gov/search/searchresults.aspx?term=heart+failure

19.

National Institutes of Health . (2004). Research repositories, databases, and the HIPAA privacy rule (04-5489). Retrieved September 23, 2006 from http://privacyruleandresearch.nih.gov/pdf/research_repositories_final.pdf

20.

National Quality Measures Clearinghouse . (2008). Heart failure: Percentage of patients with heart failure readmitted for acute episode of heart failure. Retrieved January 15, 2008 from http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=6415

21.

O'Connor

L. J.

(2008). Oral health care. In Capezti

Zwicker

Mezey

Fulmer

(Eds.), Evidence-based geriatric nursing protocols for best practice (3rd ed., pp.391–402). New York: Springer.

22.

Partnership to Improve Patient Care . (2010). PIPC applauds new Health Care Bill's CER language. Retrieved April 16, 2010 from http://eon.businesswire.com/portal/site/eon/permalink/?ndmViewId=news_view&newsId=20100323007291&newsLang=en

23.

Phillips

C. O.

Wright

S. M.

Kern

D. E.

Singa

R. M.

Shepperd

Rubin

H. R.

(2004). Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: A meta-analysis. Journal of the American Medical Association, 291, 1358–1367. doi: 10.1001/jama.291.11.1358

24.

Roberts

S. L.

Johnson

L. H.

Keely

(1999). Fostering hope in the elderly congestive heart failure patient in critical care. Geriatric Nursing, 20(4), 195–199. doi: 10.1053/gn.1999.v20.101103001

25.

Rosamond

Flegal

Friday

Furie

Greenlund

N. H.

, . . . Hong

(2007). Heart disease and stroke statistics-2007 update: A report from the American Heart Association statistics committee and stroke statistics subcommittee. [Electronic Version]. Circulation, 115, e69–e171. doi: 10.1161/CIRCULATIONAHA.106.179918

26.

Scherb

C. A.

(2002a). Describing nursing effectiveness through standardized nursing languages and computerized clinical data. Dissertation Abstracts International, 62(12), 5646. (UMI No. 3034148).

27.

Scherb

C. A.

(2002b). Outcomes research: Making a difference in practice. Outcomes Management, 6(1), 22–26.

28.

Scherb

C. A.

(2004). Hospital nursing effectiveness: Elders with pneumonia and heart failure. Grant application funded by the Gerontological Nursing Interventions Research Center and the Hartford Center for Geriatric Nursing Excellence, The John A. Hartford Foundation, University of Iowa College of Nursing.

29.

Scott

L. D.

Setter-Kline

Britton

A. S.

(2004). The effects of nursing interventions to enhance mental health and quality of life among individuals with heart failure. Applied Nursing Research, 17(4), 248–256. doi: 10.1016/S0897-1897(04)00074-6

30.

Shever

L. L.

Titler

Dochterman

Fei

Picone

D. M.

(2007). Patterns of nursing intervention use across 6 days of acute care hospitalization for three older patient populations. International Journal of Nursing Terminologies and Classification, 18(1), 18–29. doi: 10.1111/j.1744-618X.2007.00044.x

31.

Stanley

(1999). Congestive heart failure in the elderly. Geriatric Nursing, 20(4), 180–186. doi: 10.1053/gn.1999.v20.101094001

32.

Titler

Dochterman

Reed

(2004). Guideline for conducting effectiveness research in nursing & other healthcare services. Iowa City: The University of Iowa.