Standardized nursing languages in orthopedics from the perspective of the nursing role effectiveness model

Silva, Marcos Barragan da; Engelman, Bruna; Figueiredo, Manoela Schmarczek; Almeida, Miriam de Abreu

doi:10.1590/1983-1447.2022.20210321.en

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Revista Gaúcha de Enfermagem

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Sumário

Original Article • Rev. Gaúcha Enferm. 43 • 2022 • https://doi.org/10.1590/1983-1447.2022.20210321.en copy

Standardized nursing languages in orthopedics from the perspective of the nursing role effectiveness model

Lenguajes estandarizados de enfermería en ortopedia desde la perspectiva del nursing role effectiveness model

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze the standardized nursing languages in orthopedics from the perspective of the Nursing Role Effectiveness Model.

Method

Mixed method research carried out in a hospital in southern Brazil between April 2016 and February 2017. Quantitative data were collected from 85 orthopedic patients using the NANDA-International, Nursing Interventions and Outcomes, and submitted to statistical analysis. Qualitative data were collected through interviews with 10 nurses and were analyzed using content analysis.

Results

Acute pain (96%) was a prevalent nursing diagnosis. Fall Prevention (33.3%) was the most prescribed intervention. Pain Level, Body Positioning: self-initiated and Mobility showed an increase in outcome scores (p<0.001). In the interviews, nurses indicated that priority diagnoses and nursing interventions contributed to improving mobility outcomes.

Conclusion

The findings revealed that the focus of Standardized Nursing Languages in orthopedics from the perspective of the Nursing Role Effectiveness Model lies in the context of mobility, but it needs improvements in diagnostic accuracy and electronic health record.

Keywords
Nursing process; Nursing diagnosis; Orthopedic nursing

NIC Interventions for Acute Pain	Nursing care	Rateof Nursing prescriptions
NIC Interventions for Acute Pain	Nursing care	1^st Day n=82	2^ndDay n=82	3^rd Day n=82	4^th Day n=58
Pain Control	Recording pain as the fifth vital sign	62 (76)	63 (77)	63 (77)	45 (78)
	Administering analgesia after evaluation	49 (60)	49 (60)	48 (58)	37 (65)
	Evaluating the characteristic, location and intensity of pain using a verbal categorical scale	37 (45)	41 (50)	37 (45)	37 (65)
	Communicating pain signals	29 (35)	29 (35)	29 (35)	21 (37)
	Reassessing pain 30 minutes to 1 hour after management	25 (30)	26 (32)	26 (32)	20 (35)
	Reportingdisorders during infusion of analgesics	25 (30)	24 (29)	24 (29)	15 (26)
	Assessing pain intensity	20 (24)	20 (24)	19 (23)	11 (19)
	Implementing cryotherapy care	15 (18)	15 (18)	15 (18)	13 (16)
Vital signs monitoring	Checking vital signs	20 (24)	20 (24)	20 (24)	13 (23)
Positioning	Maintaining proper position for the procedure	17 (21)	17 (21)	17 (21)	13 (23)
NIC interventions for Risk for Falls	Nursing care	Rate of Nursing Prescriptions
NIC interventions for Risk for Falls	Nursing care	1^st Day n=(53)	2^nd Day n=(53)	3^rd Day n=(53)	4^th Day n=(39)
(6490) Fall prevention	Keeping bed in the lowest position	36 (68)	35 (66)	34 (64)	26 (67)
	Implementing fall prevention measures	33 (62)	33 (62)	35 (66)	27 (69)
	Making sure bed wheels are locked	34 (64)	33 (62)	34 (64)	28 (72)
	Implementing care according to the fall assistance protocol	32 (60)	31 (58)	32 (60)	25 (64)
(0840) Positioning	Keeping the bell withinreach of patients	32 (60)	31 (58)	31 (58)	23 (59)
	Using full-length bed side rail	32 (60)	31 (58)	31 (58)	24 (61)
	Keeping patients’belongings nearby	30 (57)	29 (55)	29 (55)	22 (56)
	Monitoringuse of wristbands on patients classified in fall risks	23 (43)	22 (41)	22 (41)	18 (46)
	Teaching the proper use of crutches, walker, cane, prosthesis	15 (28)	15 (28)	15 (28)	10 (26)
	Assisting patients inambulation	10 (19)	10 (19)	10 (19)	8 (20)
NIC interventions for Impaired Physical Mobility	Nursing Care	Rate of Nursing Prescriptions
NIC interventions for Impaired Physical Mobility	Nursing Care	1^st Day n=46	2^nd Day n=46	3^rd Day n=46	4^th Day n=30
(0221) Teaching: prescribed activity/exercises.	Teachingthe proper use of crutches, walker, cane, prosthesis	21 (46)	20 (43)	19 (41)	14 (47)
(6680) Vital signs monitoring	Checking vital signs	20 (43)	20 (43)	20 (43)	15 (50)
(0840) Positioning	Using bed with Balkan frame and trapeze	19 (41)	17 (40)	17 (40)	12 (40)
	Keeping the bell within reach of patients	16 (35)	15 (33)	14 (30)	12 (40)
	Keeping patients’ belongings nearby	10 (22)	10 (22)	9 (20)	8 (27)
(3540) Prevention of pressure ulcers (3520) Care for pressure ulcers	Implementing care protocol for the prevention and treatment of pressure ulcers	11 (24)	12 (26)	13 (28)	11 (37)
(3590) Skin supervision	Inspecting skin in search for hyperemic or ischemic spots	11 (24)	11 (24)	10 (22)	7 (23)
(6490) Fall prevention	Using full-length bed side rail	10 (22)	10 (22)	10 (22)	9 (30)
(0221) Exercise therapy: ambulation	Assisting patients in ambulation	10 (22)	9 (19)	7 (15)	5 (23)
(1801)Self-care assistance: bathing/hygiene	Assisting patients in the shower	9 (19)	8 (17)	8 (17)	7 (23)

Nursing outcomes	1^stDay (n=85)	2^ndDay (n=85)	3^rdDay (n=85)	4^thDay (n=58)	P
Pain Level	3.33 (± 0.12)^a	4.04 (± 0.11)^b	4.52 (± 0.08)^c	4.71 (± 0.09)^c	<0.001
Body positioning: Self-initiated	2.15 (± 0.13)^a	3.85 (± 0.12)^b	4.49 (± 0.09)^c	4.66 (± 0.10)^c	<0.001
Mobility	2.05 (± 0.11)^a	3.51 (± 0.12)^b	4.25 (± 0.10)^c	4.53 (± 0.10)^d	<0.001

NREM	Quantitative results	Qualitative results
Structure	Acute pain (96%); Risk for falls (62%); Impaired Physical Mobility (54%).	The main characteristic is the pain in the immediate postoperative period, as this surgery causes a lot of suffering. Impaired physical mobility, because I want the patients to leave the hospital walking. Therefore, this diagnosis has to be the priority (N1). First, It is necessary to check for pain and mobility, which is somewhat restricted to the bed. Then, gait training with the walker begins. Therefore, I will have to check the risk of falling, that is, whether the patient can fall or not (N5). Significant mobility restriction, movement limitation, many patients are bedridden, impaired mobility both in bed and out of it. Patients need help to get out of bed, go to the bathroom, make changes in position, to make all the movements. At first, I assess mobility, because it implies the risk for falling. (N8)
Process	Fall prevention (33.3%); Pain control (27%); Positioning (17%).	I won’t prescribe a bunch of usual routine care. It should be noted that patients will need care because of the pain, as they do not feel pain only in the surgical wound, they feel pain because of the restriction of movement, of surgical positioning. It is important to identify the CALOI (characteristic, location and intensity). For mobility reasons, patients should be encouraged to leave the bed, as soon as this is allowed by the protocol. On the second day, patients can sit down (N1). I know pain management, I know how to position patients in bed, keep the lower limbs abducted, apart, a side cushion must be used (N4). If I listed Risk for falls, I’m supposed to place a bracelet on the patient’s wrist and monitor him/her, not let this patient get out of bed alone, ring the bell, keep belongings nearby, so that the patients do not have to move around, help them safely move to the bathroom, keep the bed in the lowest position, raise side railings as required (N5). Based on the nursing diagnoses, the care plan is prepared and the most appropriate nursing activities and interventions are identified to compose the nursing prescription and care plan (N7). I usually mobilize patients, put them on the correct position, and help patients realize that they have to maintain this positioning, use the cushion and understand the reason for it. We do not take patients out of bed, but we supervise them, the bed bath, the way things happen, the mobilization (N10).
Outcome	Pain Level (P<0.001) Body Positioning: self-initiated (P<0.001) Mobility (P<0.001)	We have a primary nursing model and we evaluate this patient. Before evolution, I visit the patient, make prescriptions, observe what has improved or worsened, and according to the improvement or worsening in patient condition, I maintain, exclude, or worsen that diagnosis, based on the daily physical examination. Nurses typically observe the outcomes (N8). I always think a lot about the care and the outcome for patients. In practice, we write “improved” in the diagnosis or else we exclude the diagnosis. If the patient has impaired physical mobility and is able to get out of bed, use an assistive walker, walk with assistance, I can say that they are improving, but will still have impaired physical mobility at home, because they will need a walker or crutch for months (N1). We can see the progression. Impaired physical mobility improves day by day. On the first day, the patient leaves the bed if he can walk with a walker. On the second day, he is already training, and on the third day he is almost ready for discharge. The pain gradually diminishes, and I make the evaluation as the patient reports what he feels. If this were expressed in topics, it would be more precise, more objective. That's what I want, for example partially recovered mobility, recovered mobility. Everything is based on a study, on research, but in practice, this process has to be fast (N4) We carry out the assessments every 24 hours and, if necessary, carry out an assessment beforehand, which would be the NOC stage, because we do not have NOC in the system. So we make an assessment, but do not use the book, we make the assessment based on what we have already found (N7) After surgery, the pain is surgical, so it can be more controlled, because before the surgery the pain was constant, and after the surgery, patients can walk more normal Then, mobility improves and we change the nursing diagnoses (N9).

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[1] Corresponding author
Marcos Barragan da Silva E-mail: marcossbarragan@gmai.com