Developing a Nursing Needs Assessment Scale and Patient Classification System based on Nursing Activities in Comprehensive Nursing Care Units

Purpose: This study was done to develop and validate a scale for assessing nursing needs on comprehensive nursing care units and to derive a patient classification system based on nursing needs.Methods: In this methodological study, the initial items were identified through a review of the literature and surveys from nursing staff regarding the nursing needs on comprehensive nursing care units. Content validity was evaluated by nine nursing staff members from comprehensive nursing care units. To evaluate the concurrent validity and derive a patient classification system, nursing needs scores, perceived nursing needs and perceived patient severity for 216 patient cases were evaluated by five nurses. These data were analyzed using Pearson‘s correlation coefficients, one-way ANOVA with Scheffépost hoc tests and K-means clustering.Results: After evaluating content validity, the developed scale contained 64 activities in two domains: nursing intervention and assistance of daily living. Concurrent validity was verified by analyzing the differences in the nursing needs scores according to each group of perceived nursing needs and severity (p<.001) and by analyzing the correlation between the score of the developed scale and the National Health Insurance Service nursing need assessment scale (r=.68, p<.001). Based on the score of the developed scale, a patient classification system that classified nursing needs into four stages was derived.Conclusion: The developed scale represented nursing activities in comprehensive nursing care units. It also provided specific data regarding the time spent on nursing activities. Therefore, it is expected to contribute toward establishing appropriate nurse staffing strategies to provide quality patient care.

Machine Learning Based Emergency Patient Classification System

<p class="0abstract">Public Health Office and the risk map created from the patient information. Many provincial hospitals currently have to admit a large number of patients to their emergency room. Each year, the number outgrow limited medical resources, causing tremendous operational delay, and thus undermining quality of medical services. In addition, existing ER flows remain lacking means of communicating with patients’ relatives and notifying them with treatment status of patients under their care. To addresses these concerns, registered nurses with experiences are required not only to make initial patient screening and prioritization, but also to serve as liaison between physicians and patients’ relatives. These double tasks impose great burden to already overloaded medical staffs. An emergency patient classification system, based on support vector machine was developed. It was implemented as a web application, written in PHP, and running on MySQL database. GIS technology was employed to analyze spatial data and producing relevant reports. The proposed system could classify emergency patient into different groups based on their severity, according to the government standard. The resultant recommendation, verified by a nurse on duty, as well as treatment status were presented to patients’ relatives on a digital screen. Moreover, the hospital was able to use the summarized reports, in both standard and spatial forms, for its managerial purposes. The develop system could help the hospital to make the most of their limit resources for treating emergency patients. The produced reports were useful for making relevant policies and executive planning.</p>

An Evaluation of the Patient Clinical Complexity Level (PCCL) Method for the Complexity Adjustment in the Korean Diagnosis-Related Groups (KDRG)

ObjectiveTo evaluate the performance of the Patient Clinical Complexity Level (PCCL) mechanism, which is the patient level complexity adjustment factor within the Korean Diagnosis-Related Groups (KDRG) patient classification system, for explaining the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs).MethodsWe used the inpatient claims data from a public hospital in Korea from January 1, 2017 to June 30, 2019, with 18,846 claims and 138 Age Adjacent Diagnosis-related groups (AADRGs). The differences in the total average payment between the four PCCL levels for each AADRG was tested using ANOVA and Duncan’s post-hoc test. The three patterns of the differences with R-squared were: the PCCL reflected the complexity well (Valid); the average payment of PCCL 2, 3, 4 was greater than PCCL 0 (Partially Valid); the PCCL did not reflect the complexity (Not Valid).ResultsThere were 9 (6.52%), 26 (18.84%), and 103 (74.64%) ADRGs included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average R-squared in VALID, PARTIALLY VALID, and NOT VALID was 32.18%, 40.81%, and 35.41% respectively, with the average R-squared for all patterns of 36.21%.ConclusionsAdjusting using PCCL in the KDRG classification system exhibited low performance to explain the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs). As the KDRG classification system is used for reimbursement under the New DRG-based PPS pilot project with plans for expansion, there should be an overall review of the validity of the complexity and rationality of using the KDRG classification system.

CARACTERIZAÇÃO SOCIODEMOGRÁFICACLÍNICA E DIAGNÓSTICOS DE ENFERMAGEM NA ENFERMARIA PEDIÁTRICA

Objetivo: caracterizar o perfil de pacientes internados na enfermaria de pediatria e identificar os Diagnósticos de Enfermagem mais prevalentes, de acordo com a taxonomia NANDA-I. Metodologia: estudo descritivo realizado a partir de prontuários de 100 pacientes. Foram consideradas variáveis como: idade, gênero, sistema de classificação de pacientes, diagnóstico clínico e de enfermagem. Utilizou-se o programa Rcommander® para realização da análise exploratória e testes de hipóteses nãoparamétricos, sendo considerado nível de significância de 5%. Resultado: predominância do sexo masculino (71%), idade média de 7,32 anos, o Cuidado Intermediário (49%) foi o mais frequente, Pediatria foi a clínica com maior número de internações (39%), encontrados 44 diagnósticos médicos e 46 diagnósticos de enfermagem, sendo 27 considerados preponderantes. Conclusão: a realização do diagnóstico situacional possibilita um caráter norteador para as demais etapas do Processo de Enfermagem e direciona as ações de cuidado, contribuindo para a melhora contínua da qualidade e segurança dos cuidados.Descritores: Processo de Enfermagem, Diagnósticos de Enfermagem, Enfermagem Pediátrica.CLINICAL SOCIODEMOGRAPHICAL AND DIAGNOSTIC CHARACTERIZATION OF NURSING IN PEDIATRIC NURSINGOjective: to characterize the profile of hospitalized patients in the pediatric ward and to identify the most prevalent Nursing Diagnoses, according to the NANDA-I taxonomy. Methodology: descriptive study based on medical records of 100 patients. Variables such as: age, gender, patient classification system, clinical and nursing diagnosis were considered. The Rcommander® program was used to perform the exploratory analysis and tests of non-parametric hypotheses, being considered level of significance of 5%. Results: predominance of males (71%), mean age of 7.32 years, Intermediate Care (49%) was the most frequent, Pediatrics was the clinic with the greatest number of hospitalizations (39%), 44 medical and 46 nursing diagnoses, of which 27 were considered as preponderant. Conclusion: the accomplishment of the situational diagnosis allows a guiding character for the other stages of the Nursing Process and directs care actions, contributing to the continuous improvement of quality and safety of care.Descriptors: Nursing Process; Nursing Diagnostics; Pediatric Nursing.CARACTERIZACIÓN SOCIODEMOGRÁFICA Y DIAGNÓSTICA CLÍNICA DE ENFERMERÍA EN ENFERMERÍA PEDIÁTRICAObjetivo: caracterizar el perfil de pacientes internados en la enfermería de pediatría e identificar los Diagnósticos de Enfermería más prevalentes, de acuerdo con la taxonomía NANDA-I. Metodología: estudio descriptivo realizado a partir de prontuarios de 100 pacientes. Se consideraron variables como: edad, género, sistema de clasificación de pacientes, diagnóstico clínico y de enfermería. Se utilizó el programa Rcommander® para realizar el análisis exploratorio y pruebas de hipótesis no paramétricas, siendo considerado nivel de significancia del 5%. Resultado: En la mayoría de los casos, el cuidado intermedio (49%) fue el más frecuente, la Pediatría fue la clínica con mayor número de internaciones (39%), encontrados 44 diagnósticos médicos y, 46 diagnósticos de enfermería, siendo 27 considerados preponderantes. Conclusión: la realización del diagnóstico situacional posibilita un carácter orientador para las demás etapas del proceso de enfermería y dirige las acciones de cuidado, contribuyendo a la mejora continua de la calidad y seguridad del cuidado.Descriptores: Proceso de Enfermería; Diagnósticos de Enfermería; Enfermería Pediátrica.