The association between nursing diagnoses, resource utilisation and patient and caregiver outcomes in a nurse-led home care service: longitudinal study.
BACKGROUND
The information generated by nurses through standardised nursing languages is insufficiently evaluated and exploited, mainly in home care services, as is its potential impact on outcomes.


OBJECTIVE
To find out how often nursing diagnoses are made during nursing home care visits, and to explore their relation with use of resources, mortality, institutionalisation and satisfaction.


METHODS
Observational, longitudinal follow-up study.


METHODS
Home care services delivered by Primary Healthcare Districts in Málaga, Costa del Sol, Almería and Granada, in Spain.


METHODS
Patients and caregivers who initiated the Home Care Programme.


METHODS
The accumulated incidence of nursing diagnosis was analysed over 34 months of follow-up. Diagnoses were made by nurse case managers in their daily practice. Several regression models were devised to analyse their linkage with the use of resources, mortality, institutionalisation and satisfaction.


RESULTS
Two hundred and forty-seven subjects were included (129 patients and 118 caregivers). 93.8 had been diagnosed (2.8 diagnoses per subject). Risk of caregiver strain and mobility impairment accounted for 40% of total home visits (p=0.033). Significant differences were observed in the use of physiotherapy and rehabilitation services. The home visits for caregivers were, in 78% of cases, due to the recipient's baseline functional status. No relation was detected for institutionalisation or for patient satisfaction. There was a higher rate of anxiety diagnosed in the caregiver when the recipient was at greater risk for mortality (RR: 2.08 CI 95%: 1.26-3.42) (p=0.012).


CONCLUSIONS
These data confirm results from other studies which find nursing diagnoses to be sound predictors of resources use. Their synergy with other case-mix systems in home care should be investigated.
Morales-Asencio
J M
JM
Andalusian School of Public Health, Granada, Spain. josem.morales.easp@juntadeandalucia.es
Morilla-Herrera
J C
JC
Martín-Santos
F J
FJ
Gonzalo-Jiménez
E
E
Cuevas-Fernández-Gallego
M
M
Bonill de Las Nieves
C
C
Tobías-Manzano
A
A
Rivas-Campos
A
A
D000368:Aged; D017028:Caregivers; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009733:Nursing Diagnosis; D017063:Outcome Assessment, Health Care; D013030:Spain