Standardized Terminologies Among Patients with Heart Failure in a Home Care Setting

The use of evidence-based interventions within a clinical setting is used to evaluate the outcome of nursing practice. Hence, a standardized language based on a nursing classification system is utilized by nurses and other health care professionals to identify diagnoses, interventions, and anticipated outcomes. Research studies performed on the use of nursing classification systems in varying countries revealed that “the NANDA-International (NANDA-I), the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) are among the most widely used” (Azzolin et al., 2013, p. 239). The application and utilization of standardized nursing terminologies play a quintessential role in identifying and defining nursing care thereby enabling nurses and other health care professionals to use the same terminology when assessing the patients’ condition upon diagnosis, interventions, and outcomes within different settings (Clark & Lang, 1992, p. 110). In accordance to data collected from congestive heart failure patients, the relationship among the aforementioned standardized terminologies in nursing were established.

Studies conducted on patients with heart failure have proven that nursing classification systems have demonstrated significant benefits when applied to clinical practice. However, complications with determining and verifying diagnoses and interventions in patients with heart failure are of grave concern when assessing heart failure patients in a home care setting (Azzolin et al., 2013, p. 239). The varying signs and symptoms associated with heart failure typically result in impaired functioning in addition to poor quality of life thereby requiring the administration of medication, a strict diet regimen, as well as control and management of the patient’s intake of fluids (Bulechek et al., 2012, p. 53). Treatment can drastically improve the quality of life and the life expectancy of patients within a home care setting. In accordance to NANDA-I diagnoses, an examination of nursing interventions (NIC) using nursing outcomes (NOC) were examined in a randomized clinical trial of individuals with heart failure within a home care environment.

Although the application of NANDA-I, NIC, and NOC as nursing classification systems require more testing in clinical practice, this research study uses nursing classification systems to examine patients with heart failure in a home care setting. Research established within a home care environment has proven to be quite advantageous as compared to research conducted within a hospital setting where certain “cointerventions may hinder the evaluation” (Azzolin et al., 2013, p. 240). In a home care setting, patients with heart failure were assessed during four home visits following four phone calls after being discharged from the hospital (Azzolin et al., 2013, p. 240). Nursing diagnoses were governed and determined based on NANDA-I nursing classification, which is regulated following careful evaluation, assessment, and examination of patients with heart failure.

After NANDA-I diagnoses were determined a set of NIC interventions were implemented and nursing outcomes were evaluated thereafter. Six NANDA-I diagnoses were utilized including “readiness for enhanced self health management; ineffective self health management; ineffective family therapeutic regimen management; excess fluid volume; risk for imbalanced fluid volume; and fatigue” (Azzolin et al., 2013, p. 240). During the first home care visit, ineffective self health management was the most recurrent diagnoses at a rate of 60.9% (Azzolin et al., 2013, p. 241). During the next 3 home care visits, the most widely used diagnoses entailed the readiness for enhanced self health management at a rate of 65.3 %, 57.1%, and 55% respectively (Azzolin et al., 2013, p. 241). In accordance to the NANDA-I nursing diagnoses, a set of 11 NIC interventions alongside their corresponding activities were developed and adopted for implementation. The NIC interventions are comprised of “health education; behavior modification; self-modification assistance; telephone consultation; nutritional counseling; teaching: prescribed medication; avoiding medication errors; teaching: disease process; family involvement promotion; family mobilization; fluid monitoring; and energy management (Azzolin et al., 2013, p. 240). Since all 11 NIC interventions were based on a prior protocols, all of the aforementioned interventions were adopted in all four home care visits (Schneider & Slowil, 2009, p. 133). Nursing outcomes were measured based on the nursing interventions and respective activities used. Eight NOC outcomes were assessed including “knowledge: treatment regimen; symptom control; compliance behavior; family participation in professional care; fluid balance; knowledge: medication; activity tolerance; and energy conservation” (Azzolin et al., 2013, p. 240). Moreover, diagnoses, interventions, and outcomes based on a nursing taxonomic system are vital in assessing the condition of patients with health failure within a home care environment.

Heart failure continues to be an ongoing challenge when applying evidence-based interventions to clinical practice for patients with heart failure in a home care setting. Nurses play an essential role in promoting the delivery of quality medical care to patients with heart failure. The utilization of standardized terminologies based on a nursing classification system in nursing incorporates NANDA-I, NOC, and NIC. The application of standardized terminologies enable nurses to enhance nursing care plans therefore improving the provision of quality health care and outcomes for individuals with heart failure within a home care environment (Ehnfors & Thoroddsen, 2007, p. 1831). The NANDA-I, NIC, and NOC elements are used to examine the patients care plan in a dire effort to ascertain the most widely used diagnoses, interventions, and outcomes, which has proven to be quite advantageous among patients with heart failure in home care.

References

Azzolin, K., De Fatima Lucena, A., Mussi, C. M., Nogueira de Souza, E., Rabelo-Silva, E. R., & Ruschel, K. B. (2013). Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC. Applied Nursing Research, 26, 239-244.

Bulechek, G. M., Butcher, H. K., Johnson, M., Maas, M. L., Moorhead, S., Swanson, E. (2012). NOC and NIC linkages to NANDA-I and clinical conditions: Supporting critical reasoning and quality care (NANDA, NOC, and NIC linkages) (3rd ed.). Maryland, USA: Elsevier Mosby.

Clark J., & Lang, N. (1992). Nursing’s next advance: An internal classification for nursing practice. International Nursing Review, 39(4), 109-111.

Ehnfors, M., & Thoroddsen, A. (2007). Putting policy into practice: Pre-and posttests of implementing standardized languages for nursing documentation. Journal of Clinical Nursing, 16(10), 1826-1838.

Schneider, J. S., & Slowil, L. H. (2009). The use of the nursing interventions classification (NIC) with cardiac patients receiving home health care. International Journal of Nursing Terminologies and Classification, 20(3), 132-140.