Nursing taxonomies in hospital discharge planning: a quasi-experimental study

to evaluate the effect of implementation of hospital discharge planning based on the taxonomies of NANDA-International, nursing interventions classification (NIC) and nursing outcomes classification (NOC) for patients with heart failure (HF) or diabetes mellitus (DM).

Methods:

quasi-experimental quantitative study conducted in a public university hospital located in the state of Rio Grande do Sul, Brazil. Convenience sampling included 28 adult patients hospitalized for HF or DM with the nursing diagnosis Ineffective Health Management (00078), who received the following nursing interventions: Teaching: Disease Process, Teaching: Prescribed Medication and Teaching: Prescribed Diet. Before and after the intervention, the following nursing outcomes were evaluated : Knowledge: Diabetes Management and Knowledge: Heart Failure Management.

Results:

the score of the nursing outcome Knowledge: Heart Failure Management went from 2.05±0.28 to 2.54±0.30 (P=0.002), and of the nursing outcome Knowledge: Diabetes Management went from 2.61±0.55 to 3.21±0.57 (P=0.000).

Conclusion:

discharge planning based on the NIC improves the NOC score and may interfere in the health outcomes.

Descriptors:
Nursing; Patient Discharge; Nursing Process/Classification; Heart Failure; Diabetes Mellitus

Variable	HF (n=14)	DM (n=14)	Total (n=28)
Age^* * Mean±standard deviation;	63.1±10.6	47.1±15.8	55.1±15.5
Male sex^† † n(%);	5(35.7)	10(71.4)	15(53.6)
White race^† † n(%);	12(85.7)	12(85.7)	24(85.7)
Professional status
Inactive (Retired/on leave)^† † n(%);	12(85.7)	8(57.1)	20 (71.4)
Active (working)^† † n(%);	2(14.3)	5(35.7)	7 (25.0)
Student^† † n(%);	-	1(7.1)	1 (3.6)
Lives with a family member^† † n(%);	9(64.3)	12(85.7)	21(75)
Family income, minimum wage^‡ ‡ median(25-75 percentiles); DM = diabetes mellitus	1(1-2)	1(1-2)	1(1-2)
Years of study^‡ ‡ median(25-75 percentiles); DM = diabetes mellitus	5(2-8.2)	8(2-10)	7(2-9)
Type 1 DM^† † n(%);	-	7(50.0)	7(25.0)
Type 2 DM^† † n(%);	5(35.7)	7(50.0)	12(42.9)
Comorbidities
Arterial hypertension^† † n(%);	13(92.9)	9(64.3)	22(78.6)
Ischemic heart disease^† † n(%);	7(50.0)	3(21.4)	10(35.7)
Chronic kidney disease^† † n(%);	3(21.4)	4(28.6)	7(25.0)
Smoking (in abstinence)^† † n(%);	8(57.1)	8(57.1)	16(57.2)
Active smoking^† † n(%);	-	2(14.3)	2(7.1)
Alcoholism (in abstinence)^† † n(%);	2(14.3)	2(14.3)	4(14.3)
Time with disease, years^‡ ‡ median(25-75 percentiles); DM = diabetes mellitus	5(1.6-9.2)	14(2.7-22.5)	7(2.2-19.5)
Exams
Glycated hemoglobin^* * Mean±standard deviation;	6±1.3	11.3±2.4	10.5±3.0
Left ventricular ejection fraction^* * Mean±standard deviation;	38.6±15.7	61±0	40.1±14.2
Number of medications in use	6±1.8	5.5(4.5-8.2)	6±2.5

NOC result/ Indicators	1^st Evaluation	2^nd Evaluation	Mean difference	p value
Knowledge: Heart Failure Management (1835)	2,05±0,28	2,54±0,30	0,48±0,21	0,002
Strategies to balance activity and rest (183519)	2,36±1,27	3,57±1,22	1,21	0,002
Strategies to manage edema (183523)	1,57±0,75	2,64±0,92	1,07	0,004
Basic actions of the heart (183504)	2,43±0,85	3,43±1,01	1,00	0,002
Signs and symptoms of overexertion (183511)	2,57±1,01	3,50±0,94	0,93	0,006
Importance of rest for disease management (183518)	2,21±1,12	3,14±1,02	0,93	0,010
Cause and contributing factors (183501)	1,50±0,76	2,36±1,00	0,86	0,006
Pattern and type of edema (183522)	2,00±0,87	2,86±0,86	0,86	0,010
Factors contributing to weight changes (183524)	1,57±0,64	2,43±0,51	0,86	0,001
Signs and symptoms of progressive heart failure (183505)	2,29±0,61	3,14±0,86	0,85	0,008
Benefits of disease management (183503)	2,07±0,99	2,86±0,86	0,79	0,005
Strategies to prevent respiratory distress (183520)	2,57±1,22	3,29±0,91	0,72	0,026
Strategies to manage weight (183525)	1,36±1,08	2,07±0,99	0,71	0,004
Signs and symptoms of early disease (183502)	2,14±0,77	2,79±0,89	0,65	0,014
Medications therapeutic effects (183527)	1,57±0,85	2,21±0,97	0,64	0,014
Strategies to control anxiety (183515)	1,43±0,51	2,00±0,78	0,57	0,011
Strategies to increase diet compliance (183526)	2,57±1,01	3,14±0,94	0,57	0,046
When to obtain assistance from health professional (183537)	2,86±1,02	3,43±0,85	0,57	0,023
Signs and symptoms of tachycardia (183510)	1,93±0,61	2,43±0,85	0,50	0,020
Self-monitoring techniques (183531)	2,07±1,07	2,57±1,01	0,50	0,035
Strategies to promote peripheral circulation (183517)^ǁ	1,29±0,46	1,71±0,61	0,42	0,034
Treatments to improve cardiac performance (183516)^ǁ	1,57±0,64	1,86±0,77	0,29	0,046
Signs and symptoms of orthostatic hypotension (183506)‡	1,43±0,51	1,71±0,46	0,28	0,046

NOC result/ Indicators	1^st Evaluation	2^nd Evaluation	Mean difference	p value
Knowledge: Diabetes Management (1820)	2,61±0,55	3,21±0,57	0,59±0,20	0,000
Impact of acute illness on blood glucose level (182013)^†	2,79±1,31	4,14±0,77	1,35	0,003
Proper disposal of syringes and needles (182035)^§	2,36±1,56	3,64±1,43	1,28	0,016
Preventive foot care practices (182023) ^ǁ	2,43±1,01	3,50±0,94	1,07	0,027
Plan to rotation of injection sites (182018)^§	3,18±0,87	4,09±0,53	0,91	0,015
Prescribed meal plan (182003)^¶	2,21±0,80	3,00±0,87	0,79	0,015
Procedures to be followed in treating hypoglycemia (182011)^ǁ	2,14±0,94	2,93±0,91	0,79	0,009
Actions to take in response to blood glucose levels (182015)^†	2,00±0,78	2,79±0,80	0,79	0,001
Hyperglycemia and related symptoms (182006)^†	2,36±1,15	3,14±1,02	0,78	0,009
Medication therapeutic effects (182039)^§	2,86±1,61	3,64±1,27	0,78	0,014
Role of diet in blood glucose control (182002)^¶	2,64±0,74	3,36±0,63	0,72	0,008
How to use a monitoring device (182033)^‡	2,21±1,47	2,93±1,38	0,72	0,008
Strategies to increase diet compliance (182004)^¶	2,64±0,74	3,29±0,61	0,65	0,007
Signs and symptoms of early disease (182031)^†	2,00±1,10	2,64±1,08	0,64	0,014
Hyperglycemia prevention (182007)^ǁ	2,71±0,91	3,21±0,57	0,50	0,038
Prescribed oral medication regimen (182020)^§	2,29±1,32	2,79±1,31	0,50	0,038
When to obtain assistance from a health professional (182042)^‡	3,21±1,12	3,71±1,06	0,50	0,008
Proper technique to draw up and administer insulin (182027)^§	3,36±1,02	3,82±1,25	0,46	0,025
Benefits of disease management (182024)^†	2,86±1,02	3,29±1,20	0,43	0,034

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Karina de Oliveira Azzolin karina.azzolin@gmail.com