Nursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy

to identify Nursing diagnoses in patients in home care by cross-mapping terms obtained in the anamnesis and clinical examination, with NANDA-I Taxonomy.

Method:

descriptive exploratory study, transversal type, performed with 131 patients from a home health care program in northern Minas Gerais State. With the aid of an instrument based on the theoretical model of Basic Human Needs, the terms indicators of conditions that required nursing interventions were extracted. The cross-mapping of these terms was also performed with NANDA-I Taxonomy diagnoses.

Results:

378 terms and expressions referring to 49 different diagnoses were identified in 11 of the 13 domains of NANDA-I Taxonomy.

Conclusion:

the profile of identified nursing diagnoses can contribute to care management and organizational processes of nurses who provide care to patients in home care.

Descriptors:
Home-care Patients; Homecare Services; Nursing; Nursing Diagnosis; Nursing Process

Domain	Diagnostic nursing titles (code)	n (%)
1. Health Promotion
	Sedentary lifestyle (00168)	27 (20.6)
	Low adhesion (00079)	1 (0.8)
	The Frailty Syndrome (00257)	66 (50.4)
	Risk of having the frailty syndrome (00231)	6 (4.6)
2. Nutrition
	Unbalanced nutrition: less than the bodily needs (00002)	49 (37.4)
	Risk of electrolyte imbalance (00195)	106 (80.9)
	Risk of poor volume of liquids (00028)	109 (83.2)
3. Elimination and Changing
	Constipation (00011)	21 (16.0)
	Diarrhea (00013)	1 (0.8)
	Impaired urinary elimination (00016)	87 (66.4)
	Bowel incontinence (00014)	73 (55.7)
	Functional urinary incontinence (00020)	13 (9.9)
	Risk of constipation (00015)	67 (51.1)
4. Activity/Rest
	Impaired transfer capacity (00090)	96 (73.3)
	Impaired walking (00088)	20 (15.3)
	Self-care deficit for feeding (00102)	112 (85.5)
	Self-care deficit for bathing (00108)	109 (83.2)
	Self-care deficit for intimate hygiene (00110)	97 (74.0)
	Self-care deficit for dressing (00109)	112 (85.5)
	Insomnia (00095)	64 (48.5)
	Intolerance to activity (00092)	4 (3.0)
	Impaired physical mobility (00085)	115 (87.8)
	Impaired mobility in bed (00091)	87 (66.4)
	Ineffective respiratory pattern (00032)	26 (19.8)
	Ineffective peripheral tissue perfusion (00204)	37 (28.2)
	Risk of impaired cardiovascular function (00239)	8 (6.1)
	Risk of disuse syndrome (00040)	105 (80.1)
5. Perception/Cognition
	Impaired verbal communication (00051)	82 (62.6)
	Chronic confusion (00129)	13 (9.9)
	Poor knowledge (00126)	28 (21.4)
	Impaired memory (00131)	78 (59.5)
	Risk of acute confusion (00173)	3 (2.3)
6. Self-perception
	Despair (00124)	22 (16.8)
7. Roles and Relationships
	Impaired social interaction (00052)	94 (71.7)
	Interrupted family processes (00060)	21 (16.0)
9. Confrontation/ Stress tolerance
	Chronic sadness (00137)	1 (0.8)
10. Life Principles
	Provision for improved decision making (00184)	1 (0.8)
	Impaired religiosity (00169)	47 (35.9)
11. Safety/ Protection
	Hypothermia (00006)	4 (3.0)
	Impaired skin integrity (00046)	72 (55.0)
	Risk of air intake (00039)	76 (58.0)
	Risk of infection (00004)	78 (59.5)
	Risk of impaired skin integrity (00047)	40 (30.5)
	Risk of dry eyes (00219)	1 (0.8)
	Risk of Falls (00155)	58 (44.3)
	Risk of pressure ulcers (00249)	104 (79.4)
12. Comfort
	Acute pain (00132)	5 (3.8)
	Chronic pain (00133)	45 (34.3)
	Nausea (00134)	17 (13.0)

Domain/Diagnosis (code)	Defining characteristics	n (%)	Related factors	n (%)
D3/Impaired urinary elimination (00016)	Dysuria	3 (2.3)	Sensory motor deficits	3 (2.3)
	Frequency	7 (5.3)	Multiple causes	85 (64.9)
	Urinary incontinence	81 (61.8)	Urinary tract infection	1 (0.8)
	Nocturia	2 (1.5)
	Urinary retention	2 (1.5)
D4/Impaired transfer capacity (00090)	Impaired ability to move from bed to chair	96 (73.3)	Change in cognitive functions	68 (51.9)
			Pain	20 (15.3)
			Musculoskeletal disorders	16 (12.2)
			Neuromuscular diseases	60 (45.8)
D4/Self-care deficit for feeding (00102)	Impaired ability to eat in an acceptable way	79 (60.3)	Change in cognitive functions	71 (54.2)
	Impaired ability to prepare food	33 (25.2)	Discomfort	1 (0.8)
			Perceptual disorders	1 (0.8)
			Pain	32 (24.4)
			Musculoskeletal disorders	62 (47.3)
			Neuromuscular diseases	69 (52.7)
D4/Self-care deficit for bathing (00108)	Impaired ability to access the bathroom	17 (13.00)	Change in cognitive functions	69 (52.7)
	Impaired ability to wash the body	95 (72.5)	Pain	34 (25.9)
			Musculoskeletal disorders	64 (48.8)
			Neuromuscular diseases	68 (51.9)
D4/Self-care deficit for intimate hygiene (00110)	Impaired ability to perform intimate hygiene	94 (71.7)	Change in cognitive functions	68 (51.9)
	Impaired ability to reach the toilet	3 (2.3)	Impaired transfer capacity	85 (64.9)
	Impaired ability to handle clothes to perform intimate hygiene	1 (0.8)	Pain	28 (21.4)
	Impaired ability to sit on the toilet	1 (0.8)	Musculoskeletal disorders	56 (42.7)
			Neuromuscular diseases	59 (45.0)
D4/Self-care deficit for dressing (00109)	Impaired ability to maintain one's physical appearance	78 (59.5)	Change in cognitive functions	70 (53.4)
	Impaired ability to wear each item of clothing item (e.g. shirt, socks, shoes)	16 (12.2)	Discomfort	1 (0.8)
	Impaired ability to pick clothing items	15 (11.4)	Pain	35 (26.7)
	Impaired ability to wear lower body clothing items	3 (2.3)	Musculoskeletal disorders	65 (49.6)
			Neuromuscular diseases	71 (54.2)
D4/Impaired physical mobility (00085)	Reduction of fine motor skills	34 (25.9)	Change in cognitive functions	65 (49.6)
	Reduction of gross motor skills	76 (58.0)	Change in the integrity of bone structures	52 (39.7)
	Reduction of range of motion	82 (62.6)	Disuse	39 (29.8)
	Difficulties to turn around	82 (62.6)	Pain	26 (19.8)
			Musculoskeletal disorders	58 (44.3)
			Neuromuscular diseases	67 (51.1)
D4/Impaired mobility in bed (00091)	Impaired ability to reposition oneself in bed	68 (51.9)	Change in cognitive functions	62 (47.3)
	Impaired ability to turn from side to side	20 (15.3)	Pain	26 (19.8)
			Musculoskeletal disorders	44 (33.6)
			Neuromuscular diseases	51 (38.9)
D5/Impaired verbal communication (00051)	Slurred speech	4 (3.0)	Change in development	4 (3.0)
	Difficulty to speak	7 (5.3)
	He/she does not speak	51 (38.9)	Physical barrier	12 (9.2)
	Refuses to speak	7 (5.3)	Physiological condition	24 (18.3)
	Improper verbalization	13 (9.9)	Altered perception	20 (15.3)
	Disorientation towards people	12 (9.2)	Damage to the central nervous system	52 (39.7)
	Spatial disorientation	12 (9.2)
	Time disorientation	12 (9.2)
D7/Impaired social interaction (00052)	Impaired social function	94 (71.7)	Environmental barriers	89 (67.9)
			Communication barriers	60 (45.8)
			Impaired mobility	85 (64.9)
			Disturbed thought processes	17 (13.0)

Domain/Diagnosis (code)	Risk factors	n (%)
D2/ Risk of electrolyte imbalance (00195)	Poor volume of liquids	99 (75.6)
	Vomiting	16 (12.2)
	Diarrhea	1 (0.8)
D2/ Risk of poor volume of liquids (00028)	Poor knowledge about needs for liquid intake	50 (38.2)
	Deviations affecting fluid intake	35 (26.7)
	Extremes of age	71 (54.2)
	Barriers to access liquids	72 (55.0)
	Loss of fluid through abnormal passages	17 (13.2)
D4/Risk of disuse syndrome (00040)	Pain	33 (25.2)
	Consciousness level altered	68 (51.9)
	Paralysis	74 (56.5)
D11/Risk of pressure ulcers (00249)	Braden Scale Score <18	85 (64.9)
	Change in cognitive functions	65 (49.6)
	Change in sensitivity	54 (41.2)
	Dehydration	22 (16.8)
	Extremes of age	65 (49.6)
	Shearing forces	99 (75.6)
	Feminine gender	62 (47.3)
	History of stroke	30 (22.9)
	History of trauma	18 (11.4)
	History of pressure ulcer	60 (45.8)
	Pressure on bone prominence	64 (48.8)
	Reduction in mobility	99 (75.6)

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[1] Corresponding Author: Diego Dias de Araújo. E-mail: diego.dias1508@gmail.com