Rev Cuid. 2021; 12(1): e1944
http://dx.doi.org/10.15649/cuidarte.1944
Correlation between diagnoses, outcomes and nursing interventions in the care of patient hospitalized by COVID-19
Alba Luz Rodríguez-Acelas 1, Daniela Yampuezán Getial 2, Wilson Cañon-Montañez 3
History
Received: september 30th de 2020
Accepted: october 2th de 2020
Published: november 13th de 2020
How to cite this article: Rodríguez-Acela Alba Luz, Yampuezán Getial Daniela, Cañon-Montañez Wilson. Correlación entre diagnósticos, resultados e intervenciones de enfermería en el cuidado al paciente hospitalizado por COVID-19. Revista Cuidarte. 2021;12(1):e1944. http://dx.doi.org/10.15649/cuidarte.1944
Atribución 4.0 Internacional (CC BY 4.0)
As confirmed by the World Health Organization (WHO) in 2020, COVID-19 is an infectious respiratory disease caused by a new virus belonging to the family Coronoviridae. It has a large ribonucleic acid (RNA) genome and helical symmetry. Spikes found on their viral envelope are the main feature of these viruses, giving them a crown shape appearance. In addition, these spikes along with envelope proteins allow to anchor themselves to host cell receptors1.
Various coronaviruses such as Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and current COVID-19 have been known to cause common colds and more severe illnesses which have led to complications and the death of thousands of people. The 2002 SARS outbreak caused 8,300 reported cases and 785 deaths, while the 2012 MERS outbreak caused 1,879 reported cases at a mortality rate of 39%2.
The WHO has carried out close monitoring to make daily reports of confirmed COVID-19 cases and deaths in different regions of the world 3. Considering that this disease has a reproduction rate of R0=2.28 caused by its rapid spread in comparison with other coronaviruses 4, the virus is easily transmitted via respiratory droplets (aerosols) and direct/indirect contact by contaminated fomites of those aerosols 5, together with the lack of compliance to biosafety protocols in the population, which have ultimately resulted in an uncontrolled spread of the virus.
This growing data has triggered a global crisis affecting different aspects of the population. In terms of health, while the WHO issued some infection prevention guidelines, each country decided to arrange its own
control measures to prevent the virus’ rapid spread and hospital collapse. While some people
may be asymptomatic, others may present mild or moderate symptoms that require home care
or hospitalization in non-critical care areas, a large number of people presents a significant deterioration
requiring ICU care, where ICU are deemed as areas with limited capacity due to the
requirements of adequate equipment and trained staff, which ultimately lead to high costs related
to patients’ stay 4.
In light of this situation, nursing has been taking up the challenge in different fields of work
such as the community field where self-care measures have been promoted to empower the
population. However, these measures largely depend on the adherence that each individual has
to social distancing, hand washing, use of face masks, avoiding crowded places, among others 6.
In addition, specific social isolation measures have been implemented for vulnerable populations
who are at higher risk of dying from the disease such as the elderly, patients with chronic
diseases, people with immunocompromising conditions due to secondary comorbidities1, all of
who have been subjected to mandatory preventive isolation measures to avoid complications.
Regarding hospital areas, care dynamics vary depending on patient complexity as the infection
can progress to severe disease, including dyspnea and chest discomfort, consistent with pneumonia
in 75% of cases 7. The time period from the onset of COVID-19 symptoms to death ranges
between 6-41 days with a 14-day median. This time period depends on the patient’s immune
system and age 8. All these variables are aimed at critical care, in which healthcare professionals
and patients face great challenges and vulnerabilities.
In this complex context, the role of nursing is full of challenges with a focus on dignified care
across all healthcare areas. However, the greatest challenges lie in the transition towards inpatient
care of patients with COVID-19. Firstly, there is a constant need for healthcare professionals
to expand their knowledge in response to a virus that is evolving and transforming the way
healthcare is usually perceived. Secondly, uncertainty and discomfort are present in patients,
which makes it imperative to provide comprehensive care in line with this new reality, in which
safeguarding lives and restoring health are paramount9.
This situation has revealed the leading role that nursing
plays through individualized and planned care, supported
through the production and validation of nursing
knowledge and professional practice in all areas, which
aims at relevant quality care for patients, families, caregivers
and communities 9.
From this perspective, nursing care is organized and
guided by the Nursing Process (NP) 10, which was developed
as a response to the need to guide nursing practice
around critical thinking and clinical judgment in order to
achieve the expected results, so that nursing professionals
provide appropriate care and develop rational decision-making 11. Although the NP is structured
through different paths, sometimes healthcare professionals can only make it mentally.
However, this process is supported by IT systems in some institutions, which provide a complete
articulation to the Standardized Language Systems (SLS): NANDA-I nursing diagnoses 12,
Nursing Outcomes Classification (NOC) 13 and Nursing Interventions Classification (NIC). Each of
these taxonomies has a defined and organized participation with NP6.
Integrating SLSs provides better visibility of care since diagnoses facilitate the consolidation of
clinical judgment, outcomes lead to measure the impact of care and interventions are focused on prioritizing healthcare demanded by patients, thus achieving greater synergy that results in
a practice focused on addressing needs, which also benefits the quality of care. A close relationship
among SLSs is further outlined during planning, as shown in Table 1, through main nursing
diagnoses, outcomes and interventions in inpatient care of patients with COVID-19.
Table 1. Diagnoses, outcomes and nursing interventions identified in inpatient care of the patient with COVID-19
NANDA-I. NOC and NIC linkages in inpatient care of patients with COVID-19 consist of data collection showing the coordination of disciplinary knowledge with nursing classification in practice, thus making visible how useful these are in a systematic approach in providing care to this population in order to monitor the evolution of patient care through outcomes and interventions 11. Classification linkage shows that a large number of NANDA- I domains have been altered, suggesting that the presence of one or more diagnoses can be determined based on the patient’s commitment, which in turn leads to the selection of NOC outcomes and NIC interventions. The correspondence among classifications reveals the need for consistent care based on critical judgment and supported by philosophical, conceptual, theoretical and research production of the nursing profession.
In conclusion, although the evidence of NP-driven care based on classifications 12 - 15 provides
support for health care and work of nursing professionals, it also promotes quality and optimization
of time, indicators, resources and the needs of individuals, which is ultimately at the
heart of the profession where nurses aim to guide inpatient care of patients with COVID-19 from
a critical thinking perspective, taking up-to-date information about the disease and contributing
to the management of the pandemic impact for both healthcare staff and patients, from a
physical, psychological and social point of view that will ultimately impact the overall health
and well-being of the population.
Conflict of interest: The authors declare that there is no conflict of interest.
References