Assessment of nursing care using indicators generated by software

cross-sectional study using data collected for four months. RNs and students daily registered patients, took history (at admission), performed physical assessments, and established nursing diagnoses, nursing plans/prescriptions, and assessed care delivered to 17 patients using software. Indicators concerning the incidence and prevalence of nursing diagnoses, rate of effectiveness, risk diagnoses, and rate of effective prevention of complications were computed.

RESULTS:

the Risk for imbalanced body temperature was the most frequent diagnosis (23.53%), while the least frequent was Risk for constipation (0%). The Risk for Impaired skin integrity was prevalent in 100% of the patients, while Risk for acute confusion was the least prevalent (11.76%). Risk for constipation and Risk for impaired skin integrity obtained a rate of risk diagnostic effectiveness of 100%. The rate of effective prevention of acute confusion and falls was 100%.

CONCLUSION:

the efficacy of the Nursing Process using indicators was analyzed because these indicators reveal how nurses have identified patients' risks and conditions, and planned care in a systematized manner.

Nursing Process; Intensive Care Units; Quality Indicators; Health Care; Software Validation

Nursing diagnoses	Number of cases that developed to a real condition	Number of cases that developed real conditions with risk previously documented	Rate of risk diagnostic effectiveness (%)
Risk for confusion	03	0	0
Risk for constipation	03	03	100
Risk for imbalanced body temperature	06	07	85.7
Risk for impaired skin integrity	10	10	100
Risk for falls	0	0	-

Nursing diagnoses	Number of cases at the risk of complication	Number of cases at the risk of complication but which did not developed and actions prescribed	Rate of effectiveness in the prevention of complications (%)
Risk for acute confusion	02	02	100
Risk for constipation	13	10	76.9
Risk for imbalanced body temperature	15	11	73.4
Risk for impaired skin integrity	17	12	70.6
Risk for falls	15	15	100

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding Author: Tânia Couto Machado Chianca Universidade Federal de Minas Gerais. Escola de Enfermagem Av. Professor Alfredo Balena, 190 Bairro: Santa Efigênia CEP: 30130-100, Belo Horizonte, MG, Brasil E-mail: taniachianca@gmail.com