Differential diagnostic validation of impaired memory and chronic confusion
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NANDA International 2012 Conference Abstract
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Session 2.5
Clinical Judgement Track


Author
Priscilla Souza

Question
To evaluate the effectiveness of implementing nursing interventions (NIC) through nursing outcomes (NOC) in home care for patients with HF, in order to maintain clinical stability, to prevent emergency appointments as well as admissions for decompensated HF (Guevara,Estupiñan & Díaz,2010). The clinical stability in patients with heart failure (HF) is a challenge for healthcare staff. There are different causes of readmission for decompensated HF, and the nonadherence to therapeutic regimen is one of the major cause (Castro,et al,2010). There is evidence that many of these crises could have been avoided through the implementation of nursing care protocols and assessment of patients.

Results / Findings
30 papers were analyzed, 15 (50%) of them were characterized as observational study. Regarding the distribution between the two nursing diagnoses based on its subject matter, 5 (16.7%) of the papers were directed towards Impaired Memory, 4 (13.3%) examined Chronic Confusion, and 21 (70.0%) discussed both diagnoses, giving an evidence of similarity. For the NDIM were identified two Defining Characteristics (DC) as main: “inability to determine if an action was performed”, with score of 0.86 and “inability to learn new skills” (0.89). In relation to the Related Factors (RF), three were considered secondary: “neurological disturbances”, “hypoxia” and “decreased cardiac output”, with scores of 0.78, 0.70 and 0.66 respectively, and no primary RF. In nursing diagnosis CC there were no main DC. The majority of the eight DC remained with scores between 0.79 and 0.63, and 2 with values lower than these: “clinical evidence of organic impairment”, with score of 0.57 and 0.46 for “no change in level of consciousness”. On the RF, in a total of five, the three highest obtained scores were “cerebral vascular attack”, 0.83, “multi-infarct dementia” 0.81, and the last, “Alzheimer's disease” 0.81.

Discussion / Conclusion
The results showed little specificity for these diagnoses, with the absence of significant differences between the DC and the RF of Nursing Diagnoses Impaired Memory and Chronic Confusion. The similarities identified by nurses confirmed the results of the integrative review and also reinforced the data obtained in the differential diagnostic validation.

Methods
Cohort study in the home environment, with four home based-intervention(HBI) within six months after hospital discharge,  evaluating nursing diagnoses (ND), outcomes (Moorhead,Johnson & Maas,2008) and interventions (Dochterman & Bulechek,2008). The sample consisted of 23 patients. We obtained the average score of outcome indicators in each HBI, and then the difference among averages was calculated.

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