[Nursing diagnoses, interventions and outcomes--application and impact on nursing practice: a systematic literature review].
The aim of this paper is to report a systematic literature review on the outcomes of nursing diagnostics. Specifically, it examines effects on documentation of assessment quality; frequency, accuracy and completeness of nursing diagnoses; and on coherence between nursing diagnoses, interventions and outcomes. Escalating health care costs demand the measurement of nursing's contribution to care. Use of standardized terminologies facilitates this measurement. Although several studies evaluated nursing diagnosis documentation and their relationship with interventions and outcomes, a systematic review was lacking. A MEDLINE, CINAHL, and Cochrane Database search (1982-2004) was conducted and enhanced by the addition of primary source and conference proceedings articles. Inclusion criteria were established and applied. Thirty-six articles were selected and subjected to thematic content analysis, then each study was assessed, and a level of evidence and grades of recommendations assigned. Nursing diagnosis use improved the quality of documented patient assessments (n = 14 studies), the identification of commonly occurring diagnoses within similar settings (n = 10), and coherence among nursing diagnoses, interventions, and outcomes (n = 8). Four studies employed a continuing education intervention and found significant improvements in the documentation of diagnoses, interventions and outcomes. However limitations in diagnostic accuracy, reporting of signs/symptoms, and etiology were also reported (14 studies). Despite variable results, the trend indicated that nursing diagnostics improved assessment documentation, the quality of interventions reported, and outcomes attained. The study reveals deficits in reporting of signs/symptoms and etiology. Consequently, staff educational measures to enhance diagnostic accuracy are recommended. The relationships among diagnoses, interventions and outcomes require further evaluation. Studies are needed to determine the relationship between the quality of documentation and practice.
Müller-Staub
Maria
M
muellerstaub@bluewin.ch
Lavin
Mary Ann
MA
Needham
Ian
I
van Achterberg
Theo
T
D004282:Documentation; D006801:Humans; D009732:Nursing Care / Q000592:standards*; D009733:Nursing Diagnosis; D016896:Treatment Outcome