Copyright B 2018 Wolters Kluwer Health, Inc. All rights reserved. Gianfranco Sanson, PhD Rosaria Alvaro, MSN Antonello Cocchieri, PhD Ercole Vellone, PhD John Welton, PhD Massimo Maurici, MD Maurizio Zega, PhD Fabio D’Agostino, PhD Nursing Diagnoses, Interventions, and Activities as Described by a Nursing Minimum Data Set A Prospective Study in an Oncology Hospital Setting KEY WORDS Background: Oncological diseases affect the biopsychosocial aspects of a Nursing activities person’s health, resulting in the need for complex multidisciplinary care. The quality Nursing diagnosis and outcomes of healthcare cannot be adequately assessed without considering the Nursing interventions contribution of nursing care, whose essential elements such as the nursing diagnoses Nursing Minimum Data Set (NDs), nursing interventions (NIs), and nursing activities (NAs) can be recorded in Oncology the Nursing Minimum Data Set (NMDS). There has been little research using the NMDS in oncology setting. Objective: The aim of this study was to describe the prevalence and distribution of NDs, NIs, and NAs and their relationship across patient age and medical diagnoses. Methods: This was a prospective observational study. Data were collected between July and December 2014 through an NMDS and the hospital discharge register in an Italian hospital oncology unit. Results: On average, for each of 435 enrolled patients, 5.7 NDs were identified on admission; the most frequent ND was risk for infection. During the hospital stay, 16.2 NIs per patient were planned, from which 25.2 NAs per day per patient were delivered. Only a third of NAs were based on a medical order, being the highest percentage delivered on nursing prescriptions. The number of NDs, NIs, and NAs was not related to patient age, but differed significantly among medical diagnoses. Conclusions: An NMDS can depict patient needs and nursing care delivered in oncology patients. Such data can effectively describe nursing contribution to patient Author Affiliations: Department of Biomedicine and Prevention, University of The authors have no conflicts of interest to disclose. Rome Tor Vergata, Rome, Italy (Drs Sanson, Vellone, Maurici, D’Agostino and Correspondence: Fabio D’Agostino, PhD, Department of Biomedicine and Alvaro); University of Colorado College of Nursing, Aurora (Dr Welton); and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, University Hospital Agostino Gemelli, Rome, Italy (Drs Cocchieri and Zega). Italy ([email protected]). This work was funded by the Italian Center of Excellence for Nursing Accepted for publication November 13, 2017. Scholarship, Rome, Italy. DOI: 10.1097/NCC.0000000000000581 Nursing Diagnoses, Interventions, and Activities Cancer NursingA, Vol. 00, No. 0, 2018 n 1 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. care. Implications for Practice: The use of an NMDS raises the visibility of nursing care in the clinical records. Such data enable comparison and benchmarking with other healthcare professions and international data. urses form the largest portion of health personnel, patient demographics (eg, age, sex), services (eg, patient’s health providing up to 80% of care in most of the world’s register number, date of admission and discharge, payment source), health services.1 Nurses are an essential part of any and nursing care (ND, nursing interventions [NIs], nursing out- N 20 health organization pursuing the goal of quality of care and comes). This data set can meet the information needs of mul- patient safety.2 For this reason, the quality of healthcare cannot tiple data users in the healthcare system, to make nursing visible be adequately determined without evaluating the effectiveness in the fields of research and healthcare effectiveness and policy of nursing in achieving patient outcomes.3 analysis.21 Regrettably, the use of the NMDS is still limited Oncological diseases represent major public health prob- worldwide.22 Only a few studies have described, mostly retro- lems,4 resulting in the need for complex treatments and high- spectively and on small groups of patients, NDs and NIs in intensity multidisciplinary care for extended periods. Such oncology hospital settings.5 No study based on electronic NMDS pathologies affect the physical integrity of cancer patients and has studied NDs, NIs, and NAs and their relationship across heavily impact their psychological health and life goals by alter- patient age and medical diagnoses in oncologic hospitalized ing their body image and impacting family, work, and incomes.5 patients. Thus, the medical diagnosis cannot exhaustively or exclusively describe the overall effects of oncological diseases on patients. Aims Using the nursing process, nurses do ensure that all aspects of patient care are identified, addressed, and documented in a The aims of this study were to (1) describe the prevalence of uniform and holistic way.6 This process gives nurses responsi- NANDA International (NANDA-I)23 NDs on admission, NIs, bility for assessing health problems and interpreting the acquired and NAs as described according to the Italian Nomenclature of information to make decisions about interventions.7 Also, the Nursing Care Performance24 in a population of hospitalized nursing process, using nursing diagnoses (NDs), complements oncology patients and (2) compare the number of NDs, NIs, a medical diagnosis to better describe care complexity.8 and NAs across (a) patient age and (b) medical diagnoses. Despite its importance, nursing practice is generally poorly represented in electronic health records,9 and this happens be- cause nursing data are often incomplete and recorded without n Materials and Methods a standardized terminology.3,10,11 This makes it impossible to analyze the impact of nursing care on health processes and out- Study Design, Setting, and Population comes, and consequently the contribution of nurses remains invisible.12 A prospective observational study was performed at the Uni- Although many years have passed since standardized NDs versity Hospital ‘‘Agostino Gemelli’’ in Rome, Italy. The hos- have been included into oncology nursing practice to ensure pital has 1547 beds organized into 8 departments and 55 inpatient comprehensive and individualized care for the oncology pa- units. The study was carried out in a 21-bed oncology unit. All tient,13 their use is still largely neglected in daily clinical prac- consecutive adult patients admitted to this unit over a period of tice. A study conducted in outpatient cancer settings reported 6months (July 1 to December 31, 2014) were considered eligible that, in daily nursing practice, nurses collect a very large number for inclusion in the study. We excluded: (a) patients with length of nonstandardized data to document the care they provide (29 of stay (LOS) of less than 2days because they could be assimilated variables, on average). These data create multiple nonuniform to ‘‘day-hospital’’ admissions, but patients who died were in- ‘‘hidden nursing data sets.’’14 Collecting standardized nursing cluded even if their LOS was shorter than 2days; (b)patients data as part of hospital care in oncology may allow a better transferred to another inpatient unit before hospital discharge; (c) understanding of patients’ complexity and allow analysis of the patients for which nursing planning was not fully documented; impact of nursing on outcomes of care.15 The analysis of such (d) patients discharged with ‘‘V64.x’’ coding according to the data may permit a more detailed measure of nursing workload. ICD-9-CM taxonomy (International Classification of Diseases, Even if nursing workload is mostly measured in relation of spe- Ninth Revision, Clinical Modification,Italianversion)25 corre- cific tasks performed by nurses,16 the complexity of care re- sponding to patients admitted for specific procedures not quired by the patients as expressed by NDs can affect the carried out because of unforeseen circumstances. number of nursing activities (NAs) needed.17,18 To gather uniform nursing information, it is necessary to Data Collection identify a standardized set of data able to intercept the essential elements of clinical nursing practice across various settings and Data were collected from the Professional Assessment Instru- patient groups.19 The Nursing Minimum Data Set (NMDS) ment (PAI)10 and the hospital discharge register. The PAI is a identifies and operationalizes a powerful but limited set of data clinical nursing information system implemented at the study representing core components of nursing practice, including hospital in February 2013. This system allows collection of the 2 n Cancer NursingA, Vol. 00, No. 0, 2018 Sanson et al Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. standard and uniform essential nursing data recommended by tient’s health code and medical record number) through a the NMDS (eg, NDs and NIs), patient’s sociodemographic probabilistic matching process30 completing the final study variables (eg, age, gender, job, level of education), and orga- data set. nizational information (eg, identification of responsible nurses, admission and discharge dates).26 The PAI includes a set of 44 Ethical Considerations NANDA-I diagnoses27 selected on the basis of a literature re- view.10 Nurses are assisted to identify NDs by a previously vali- The study was approved by the hospital ethics committee. All dated clinical decision