UNASSIGNED: To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain.
UNASSIGNED: Multicentric, mixed method concurrent study.
UNASSIGNED: This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022).
UNASSIGNED: The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic.
UNASSIGNED: Identifier: NCT05249868 [ClinicalTrials.gov].

OBJECTIVE: To assess clinical-causal validity evidence of the nursing diagnosis, risk for unstable blood glucose level (00179), in individuals with type 2 diabetes mellitus.
METHODS: A case-control study was conducted in 5 primary healthcare units, involving 107 subjects with type 2 diabetes mellitus, 60 in the case group and 47 in the control group. Causality was determined by the association between sociodemographic and clinical factors, risk factors related to the nursing diagnosis, and the occurrence of unstable blood glucose level. An association was considered when the risk factor had a p-value of <0.05 and odds ratio >1.
RESULTS: Risk factors, such as stress, inadequate physical activity, and low adherence to therapeutic regimen, were prevalent in the sample. Time since diagnosis between 1-5 and 6-10 years, multiracial ethnicity, and the risk factor of low adherence to therapeutic regimen increased the likelihood of the outcome. Completion of high school education was identified as a protective factor.
CONCLUSIONS: The clinical validation of the nursing diagnosis, risk for unstable blood glucose level, has been successfully established, revealing a clear association between sociodemographic and clinical factors and the risk factors inherent to the nursing diagnosis.
CONCLUSIONS: The results contribute to advancing scientific knowledge related to nursing education, research, and practice and provide support for the evolution of nursing care processes for individuals with type 2 diabetes mellitus.
OBJECTIVE: Avaliar a evidência de validade clínico‐causal do diagnóstico de enfermagem, risco para nível instável de glicose no sangue (00179), em indivíduos com diabetes mellitus tipo 2. MÉTODO: Foi realizado um estudo caso‐controle em cinco unidades básicas de saúde, envolvendo 107 indivíduos com diabetes mellitus tipo 2, 60 no grupo caso e 47 no grupo controle. A causalidade foi determinada pela associação entre fatores sociodemográficos e clínicos, fatores de risco relacionados ao diagnóstico de enfermagem e a ocorrência de nível instável de glicose no sangue. Uma associação foi considerada quando o fator de risco tinha um valor de p < 0.05 e odds ratio > 1.
RESULTS: Fatores de risco como estresse, atividade física inadequada e baixa adesão ao regime terapêutico foram predominantes na amostra. O tempo desde o diagnóstico entre 1 e 5 anos e 6 a 10 anos, a etnia parda e o fator de risco baixa adesão ao regime terapêutico aumentaram a probabilidade do resultado. A conclusão do ensino médio foi identificada como um fator de proteção. CONCLUSÕES: A validação clínica do diagnóstico de enfermagem, risco para nível instável de glicose no sangue, foi estabelecida com sucesso, revelando uma clara associação entre fatores sociodemográficos e clínicos e os fatores de risco inerentes ao diagnóstico de enfermagem. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os resultados contribuem para o avanço do conhecimento científico relacionado à educação, à pesquisa e à prática de enfermagem e fornecem suporte para a evolução dos processos de cuidados de enfermagem para indivíduos com diabetes.

OBJECTIVE: The rate of readmission after hospitalisation for respiratory diseases has become a common and challenging clinical problem. Social and functional patient variables could help identify cases at high risk of readmission. The aim was to identify the nursing diagnoses that were associated with readmission after hospitalisation for respiratory disease in Spain.
METHODS: Case-control study within the cohort of patients admitted for respiratory disease during 2016-19 in a tertiary public hospital in Spain (n = 3781).
METHODS: Cases were patients who were readmitted within the first 30 days of discharge, and their controls were the remaining patients. All nursing diagnoses (n = 130) were collected from the electronic health record. They were then grouped into 29 informative diagnostic categories. Clinical confounder-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using logistic regression models.
RESULTS: The readmission rate was 13.1%. The nursing diagnoses categories \'knowledge deficit\' (OR: 1.61; 95%CI: 1.13-2.31), \'impaired skin integrity and risk of ulcer infection\' (OR: 1.45; 95%CI: 1.06-1.97) and \'activity intolerance associated with fatigue\' (OR: 1.56; 95%CI: 1.21-2.01) were associated with an increased risk of suffering an episode of hospital readmission rate at 30% after hospital discharge, and this was independent of sociodemographic background, care variables and comorbidity.
UNASSIGNED: The nursing diagnoses assigned as part of the care plan of patients during hospital admission may be useful for predicting readmissions.

OBJECTIVE: Nurses\' clinical reasoning skills regarding impaired swallowing can help prevent patient complications and maintain quality of life. Clinical reasoning skills need content-validated defining characteristics (DCs). We aimed to validate the content of these DCs for nursing diagnosis \"impaired swallowing.\"
METHODS: Content validation of the DCs was performed by 275 dysphagia nursing experts in Japan, using 3 rounds of the Delphi technique and Fehring\'s Diagnostic Content Validation (DCV) model. Three rounds of questionnaires on 84 DCs were completed via printed mail.
RESULTS: The valid response rates for each round were as follows: round 1, 90.2%; round 2, 77.8%; and round 3, 71.3%. Of the 84 DCs, 77 that met the consensus criteria were categorized as major (n = 18), minor (n = 45), and excluded (n = 14). There were four minor DCs other than the oral, pharyngeal, and esophageal phases. DCs listed from outside NANDA-I included 12 major, 16 minor, and 3 excluded characteristics. Of the NANDA-I DCs, 5 were no consensus and 11 were excluded. The total DCV score for the 63 major and minor DCs was 0.8.
CONCLUSIONS: Our results recommend the addition of 28 DCs and the exclusion of 11 for the NANDA-I nursing diagnosis \"impaired swallowing\" (00103). Major DCs were prominent indicators of impaired swallowing and signs of aspiration or pharyngeal residuals. Minor DCs included not only the three phases but also other signs necessary for a comprehensive understanding of impaired swallowing.
CONCLUSIONS: This validation study strengthens the clinical usefulness of the DCs for impaired swallowing, which can improve nurses\' clinical reasoning skills. Major and minor DCs can increase the awareness of impaired swallowing and enable accurate intervention, thereby preventing patient complications and maintaining quality of life.
目的:: 看護師の嚥下障害に関する臨床推論能力は, 患者の合併症を予防し, QOLを維持するのに役立つ.臨床推論には, 内容妥当性が検証された診断指標が必要である.我々は, 看護診断「嚥下障害」の診断指標の内容妥当性検証をすることを目的とした. 方法:: 嚥下障害看護の専門家275名を対象に, デルファイ法およびFehringのDiagnostic Content Validationモデルを用いて, 診断指標の内容妥当性検証を行った.３回の診断指標84項目に関する質問紙調査が郵送法で実施された. 結果:: 各roundの有効回答率は, 第1 round 90.2％, 第2 round 77.8％, 第3 round 71.3％であった.診断指標84項目のうち, コンセンサス基準を満たした77項目は, major (n = 18), minor (n = 45), 除外 (n = 14) に分類された.口腔相, 咽頭相, 食道相以外のminorの診断指標は4項目あった.NANDA‐I以外の診断指標は, major 12項目, minor 16項目, 除外3項目であった.NANDA‐Iの診断指標のうち, 5項目はコンセンサスに至らず, 11項目は除外となった.Majorとminorを合わせた診断指標63項目のtotal Diagnostic Content Validationスコアは0.8であった. 結論:: この結果から, NANDA‐Iの看護診断「嚥下障害」(00103)の診断指標には, 28項目を追加し, 11項目を除外することが提案された.Majorの診断指標は, 嚥下障害を顕著に示す指標や, 誤嚥または咽頭残留を示す徴候であった.Minorの診断指標には, 3つの相だけでなく, 嚥下障害を包括的に理解するために必要となる「その他」の徴候も含まれた. 看護実践への示唆: この研究は, 嚥下障害の診断指標の臨床的有用性を強化し, 看護師の臨床推論能力を向上させることができる.Majorとminorの診断指標は, 嚥下障害に対する気づきを促し, 正確な介入を可能にし, 患者の合併症を予防してQOLを維持することができる.

UNASSIGNED: The introduction of accreditation criteria for hospitals has generated increased interest in applying the nursing process to clinical practice and developing nursing care plans. Nursing diagnosis plays a pivotal role in the formulation of these care plans.The objective of the study is to investigate the correlation between nursing diagnosis education and nurses\' intentions, attitudes toward the use of nursing diagnosis and the behavior in using it in practice; to explore the differences between nurses\' intentions, attitudes and behavior, considering nurses\' socio-demographic and professional data.
UNASSIGNED: A cross-sectional design was used. A web-based survey was applied to gather data. A sample of 664 hospital nurses was recruited from five Romanian hospitals.
UNASSIGNED: Education on nursing diagnosis showed significant results in relation to nurses\' intentions (F(2,126.35) = 23.99, p < 0.001), attitudes (χ2 (2, N = 664) = 44.62, p < 0.001) and behavior (F(2,167.69) = 29.53, p < 0.001) in using it in clinical practice. Nurses with education highly focused on nursing diagnosis have significantly stronger intention to use it, more positive attitudes and higher behavior in using it in clinical practice compared to nurses whose education simply had included a nursing diagnosis course, or nurses without any education on the topic. Significant differences were identified in intention (t (83.86) = -4.49, p < 0.001) and attitudes (U = 12697.50, z = -3.99, p < 0.001, r = -0.0006) of management nurses compared to clinical nurses.
UNASSIGNED: Nursing education on nursing diagnosis significantly impacts nurses\' intentions, attitudes, and behavior in their daily practice. Romanian nurses display slightly positive intention and attitudes toward nursing diagnosis but need more training for effective/practical clinical application.

OBJECTIVE: To reflect on the contributions of representing nursing practice elements in the ISO 18.104:2023 standard.
METHODS: This is a theoretical study with standard analysis. Categorical structures were described to represent nursing practice in terminological systems and contributions identified in the parts of the version were analyzed.
RESULTS: There is innovation in the inclusion of nurse sensitive outcomes, nursing action, nursing diagnosis explanation as an indicator of nursing service demand and complexity of care, representation of concepts through mental maps and suggestion of use of restriction models for nursing actions. It describes that the Nursing Process is constituted by nursing diagnosis, nursing action and nurse sensitive outcomes.
CONCLUSIONS: Indicating a nursing diagnosis as an indicator will bring benefits for knowledge production and decision-making. Although care outcomes are not exclusive responses to nursing action, the modifiable attributes of a nursing diagnosis generate knowledge about clinical practice, nursing action effectiveness and subjects of care\' health state. There is coherence in understanding the Nursing Process concept evolution.

BACKGROUND: Advances in health have highlighted the need to implement technologies as a fundamental part of the diagnosis, treatment, and recovery of patients at risk of or with health alterations. For this purpose, digital platforms have demonstrated their applicability in the identification of care needs. Nursing is a fundamental component in the care of patients with cardiovascular disorders and plays a crucial role in diagnosing human responses to these health conditions. Consequently, the validation of nursing diagnoses through ongoing research processes has become a necessity that can significantly impact both patients and health care professionals.
OBJECTIVE: We aimed to describe the process of developing a mobile app to validate the nursing diagnosis \"intolerance to physical activity\" in patients with acute myocardial infarction.
METHODS: We describe the development and pilot-testing of a mobile system to support data collection for validating the nursing diagnosis of activity intolerance. This was a descriptive study conducted with 11 adults (aged ≥18 years) who attended a health institution for highly complex needs with a suspected diagnosis of coronary syndrome between August and September 2019 in Floridablanca, Colombia. An app for the clinical validation of activity intolerance (North American Nursing Diagnosis Association [NANDA] code 00092) in patients with acute coronary syndrome was developed in two steps: (1) operationalization of the nursing diagnosis and (2) the app development process, which included an evaluation of the initial requirements, development and digitization of the forms, and a pilot test. The agreement level between the 2 evaluating nurses was evaluated with the κ index.
RESULTS: We developed a form that included sociodemographic data, hospital admission data, medical history, current pharmacological treatment, and thrombolysis in myocardial infarction risk score (TIMI-RS) and GRACE (Global Registry of Acute Coronary Events) scores. To identify the defining characteristics, we included official guidelines, physiological measurements, and scales such as the Piper fatigue scale and Borg scale. Participants in the pilot test (n=11) had an average age of 63.2 (SD 4.0) years and were 82% (9/11) men; 18% (2/11) had incomplete primary schooling. The agreement between the evaluators was approximately 80% for most of the defining characteristics. The most prevalent characteristics were exercise discomfort (10/11, 91%), weakness (7/11, 64%), dyspnea (3/11, 27%), abnormal heart rate in response to exercise (2/10, 20%), electrocardiogram abnormalities (1/10, 9%), and abnormal blood pressure in response to activity (1/10, 10%).
CONCLUSIONS: We developed a mobile app for validating the diagnosis of \"activity intolerance.\" Its use will guarantee not only optimal data collection, minimizing errors to perform validation, but will also allow the identification of individual care needs.

OBJECTIVE: To identify the prevalence of the nursing diagnosis of compromised end-of-life syndrome in patients in end-of-life care.
METHODS: This is a clinical validation based on a cross-sectional epidemiological clinical study conducted at the National Cancer Institute in Rio de Janeiro, Brazil. The defining characteristics of a syndrome diagnosis were identified, defined as a \"subset of nursing diagnoses,\" using sensitivity and specificity measures through the application of latent class statistical methods.
RESULTS: The statistical results revealed seven nursing diagnoses characterizing the syndrome: imbalanced nutrition: less than body requirements, nausea, anxiety, ineffective breathing pattern, disturbed sleep pattern, ineffective thermoregulation, and fatigue. Compromised end-of-life syndrome was present in 76% of the sample.
CONCLUSIONS: The study demonstrated the presence of compromised end-of-life syndrome in most end-of-life patients from the sample.
CONCLUSIONS: Recognizing the presence of the syndrome diagnosis enables nurses to have efficient and effective clinical reasoning for implementing the nursing process in palliative care. CAAE Number: 85415618.0.3001.5274.
OBJECTIVE: Identificar a prevalência do diagnóstico de enfermagem Síndrome de fim de vida comprometido em pacientes em cuidados de fim de vida. MÉTODO: Trata-se de uma validação clínica baseada em um estudo clínico epidemiológico transversal, desenvolvido no Instituto Nacional do Câncer no Rio de Janeiro, Brasil. Foram identificadas as características definidoras de um diagnóstico de síndrome, definido como um “subconjunto de diagnósticos de enfermagem” utilizando-se medidas de sensibilidade e especificidade a partir da aplicação do método estatístico de classe latente.
RESULTS: Os resultados estatísticos identificaram sete diagnósticos de enfermagem caracterizadores da síndrome: nutrição desequilibrada: menor que as necessidades corporais, náusea, ansiedade, padrão respiratório ineficaz, padrão de sono perturbado, termorregulação ineficaz e fadiga. O diagnóstico Síndrome de fim de vida comprometido esteve presente em 76% da amostra. CONCLUSÃO: O estudo demonstrou a presença da Síndrome de fim de vida comprometido na maioria dos pacientes em cuidados de fim de vida da amostra. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O reconhecimento da presença do diagnóstico de síndrome permite ao enfermeiro um raciocínio clínico eficaz e eficiente para a implantação do processo de enfermagem em cuidados paliativos. Número CAAE: 85415618.0.3001.5274.

OBJECTIVE: To determine the prevalence and clustering of NANDA-International nursing diagnoses in patients assisted by pre-hospital emergency teams.
METHODS: Retrospective descriptive study of electronic record review.
METHODS: Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two-step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020.
RESULTS: Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six-cluster solution (n = 26.788) was found. Five clusters had a single high-prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co-occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051).
CONCLUSIONS: Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre-hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases.
UNASSIGNED: Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre-hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre-hospital clinical setting.
CONCLUSIONS: What problem did the study address? There are different models of pre-hospital emergency care services. The use of standardized nursing languages in the pre-hospital setting is not homogeneous. Studies on NANDA-I nursing diagnoses in the pre-hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA-I nursing diagnoses in the pre-hospital care setting. Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients\' safety/protection and coping/stress tolerance. Patients attended by pre-hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre-hospital setting, increasing the evidence of individualized and standardized care plans for pre-hospital care.
UNASSIGNED: STROBE checklist has been used as a reporting method.
UNASSIGNED: Only patients\' records were reviewed without further involvement.

OBJECTIVE: To examine whether nursing diagnoses were associated with delirium in patients with sepsis.
BACKGROUND: Nursing diagnosis is a nurse\'s clinical judgement about clients\' current or potential health conditions. Delirium is regarded as an important nurse-sensitive outcome. Nonetheless, nursing diagnoses associated with delirium have not yet been identified.
METHODS: Retrospective correlational study.
METHODS: This study was carried out from December 2021 to January 2023. We analysed electronic health records of patients with sepsis admitted to the intensive care units (ICUs) of a tertiary hospital in Seoul, South Korea. Delirium was defined based on the Intensive Care Delirium Screening Checklist score. Nursing diagnoses established within 24 h of admission to the ICU were included and were based on the North American Nursing Diagnosis Association diagnostic classification. The data were analysed using logistic regression. Demographics, comorbidities, procedures and physiological measures were adjusted. Regression model was evaluated via receiver operating characteristic curve, Nagelkerke R2, accuracy and F1 score.
RESULTS: The prevalence of delirium in patients with sepsis was 51.8%. Ineffective breathing patterns, decreased cardiac output and impaired skin integrity were significant nursing diagnoses related to delirium. Age ≥ 65 years, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, continuous renal replacement therapy, physical restraint and comatose state were also associated with delirium in patients with sepsis. The area under the receiver operating characteristic curve was 0.806.
CONCLUSIONS: Ineffective breathing patterns, decreased cardiac output and impaired skin integrity could manifest as prodromal symptoms of delirium among patients with sepsis.
CONCLUSIONS: The prodromal symptoms of delirium revealed through nursing diagnoses can be efficiently used to identify high-risk groups for delirium. The use of nursing diagnosis system should be recommended in clinical practice caring for sepsis patients.
UNASSIGNED: STROBE checklist.
UNASSIGNED: No patient or public involvement.