Relations between nursing data collection, diagnoses and prescriptions for adult patients at an intensive care unit

Authors

  • Emilia Campos de Carvalho University of Sao Paulo; Ribeirao Preto College of Nursing
  • Fernanda Titareli Merizio Martins University of Sao Paulo; Ribeirao Preto College of Nursing
  • Maria Célia Barcellos Dalri University of Sao Paulo; Ribeirao Preto College of Nursing
  • Silvia Rita Marin da Silva Canini University of Sao Paulo; Ribeirao Preto College of Nursing
  • Ana Maria Laus University of Sao Paulo; Ribeirao Preto College of Nursing
  • Maria Marcia Bachion Goiás Federal University; School of Nursing
  • Lidia Aparecida Rossi University of Sao Paulo; Ribeirao Preto College of Nursing

DOI:

https://doi.org/10.1590/S0104-11692008000400008

Keywords:

nursing process, nursing diagnosis, intensive care unit

Abstract

This descriptive, retrospective study aimed to analyze the relation between nursing data collection, diagnoses and prescriptions for 26 adult patients who were hospitalized at the intense care unit of a large teaching hospital for at least 24 hours. Through the analysis of medical records, 135 diagnoses and 421 nursing prescriptions were established, and 24 different diagnosis categories and 20 different items for prescriptions were identified. The most frequent diagnosis risk was that for infection, present in the medical records of 22 (84.60%) patients, with 175 prescriptions (42%) related to this diagnosis. The data the nurses collected were sufficient to establish the nursing diagnoses, and the majority of prescriptions (87.9%) were related to the diagnoses.

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Published

2008-08-01

Issue

Vol. 16 No. 4 (2008)

Section

Original Articles

License

RLAE’s authorship concept is based on the substantial contribution by each of the individuals listed as authors, mainly in terms of conceiving and planning the research project, collecting or analyzing and interpreting data, writing and critical review. Indication of authors’ names under the article title is limited to six. If more, authors are listed on the online submission form under Acknowledgements. The possibility of including more than six authors will only be examined on multicenter studies, considering the explanations presented by the authors.
Including names of authors whose contribution does not fit into the above criteria cannot be justified. Those names can be included in the Acknowledgements section.
 Authors are fully responsible for the concepts disseminated in their manuscripts, which do not necessarily reflect the editors’ and editorial board’s opinion.

 

How to Cite

Relations between nursing data collection, diagnoses and prescriptions for adult patients at an intensive care unit. (2008). Revista Latino-Americana De Enfermagem, 16(4), 700-706. https://doi.org/10.1590/S0104-11692008000400008