The purpose of this research was to develop the clinical nursing process model through linked nursing diagnoses, related factors, defining characteristics, nursing interventions, nursing activities and nursing outcomes and was to make graphic user interface using the clinical nursing process model. The linked clinical record sets in the developed database system were arranged in reverse order statistically in order to construct the clinical nursing process model from the patients' database tables concerning nursing diagnoses, related factors, defining characteristics, nursing interventions, nursing activities and nursing outcomes. The arranged clinical nursing record sets were suggested as the nursing process model in a general surgery clinical unit. The nursing process model of a general surgery clinical unit could be used for its accessibility as an indicator for other medical departments. The most available clinical nursing process data were presented on only one graphic user interface window to be able to select the nursing process easily for nurses in a general surgery clinical unit. Graphic user interface programming was designed to show all related factors, defining character stics, nursing interventions, nursing activities and nursing outcomes based on a nursing diagnosis which have unique properties. Using the clinical nursing process model in this database system, it was also possible to construct the electronic nursing record system.
Nursing Diagnosis ; Nursing Process* ; Nursing Records ; Nursing*

PURPOSE: This study was conducted to develop a comprehensive web-based nursing process program to assist nursing students and to evaluate the effects of the program. METHODS: The system provides nursing students with guidelines based on NNN (NANDA, NOC, NIC) when the nursing students conduct a series of nursing procedures on diagnosis-outcome-intervention for a specific symptom. It also maintains and manages nursing processes actually conducted by students for clinical practices, and provides an environment where the patient information and nursing process can be converted into a formatted document for printing. This web-based program was used to surgical patients from April to June 2011. RESULTS: The overall satisfaction rate was 3.64. The item with the highest score was, 'Do you think a web-based nursing process program is necessary?' (3.87), followed by 'Do you want to use this program when you become a nurse and implement the nursing process?' (3.33). CONCLUSION: These results indicate that implementation of web-based programs needs to be continued as an effective tool, but more research is needed on the best way to implement web-based programs in various clinical setting.
Humans ; Nursing Diagnosis ; Nursing Process ; Students, Nursing

PURPOSE: The purpose of this study was to identify NANDA, NIC, and NOC frequently used and their linkages in major nursing departments for development of the nursing process and nursing management system. METHODS: This study was a descriptive study. Data were collected from 123 nurses who worked in medical, surgical, pediatric, gynecologic, and psychiatric department. The questionnaire was based on the NANDA, NOC, NIC, and NANDA-NOC-NIC linkage system. This research was analyzed by an EXCEL program and SPSS Pc+15.0. RESULTS: Nursing diagnoses frequently used were 'anxiety', 'disturbed sleep pattern', 'activity intolerance', 'social isolation', 'nausea', 'ineffective airway clearance', 'chronic pain', nursing outcomes frequently used were 'thermoregulation', 'bowel elimination', 'pain control', 'vital sign status', 'pain level', and nursing interventions frequently used were 'nausea management', 'airway suctioning', 'bowel elimination management', 'diarrhea management', 'medication management'. NANDA-NOC-NIC linkages in major nursing departments were recognized, and these results were similar to the results of other researches. CONCLUSION: The results of this study will be provided as a guideline to apply to the nursing process and development of the nursing process system with the NANDA-NOC-NIC linkage in major nursing department.
Nursing Diagnosis ; Nursing Process ; Surveys and Questionnaires

This paper proposes a system for nursing diagnosis and intervention management that is using nursing outcome indicators to guide the nursing intervention. In Korea, it has been studied on computerization of nursing process, but most of the studies are on the management of nursing records and not on the databases of nursing intervention. So far, the actual nursing processes have been performed by individual nurses' judgement without any supporting programs. Therefore, we provide the system with standardized database for nursing diagnosis and interventions so that nurses can make more accurate diagnoses and perform more adequate interventions. For that purpose, we have developed an algorithm that links nursing outcome indicators to nursing diagnoses and interventions. As a result, we expect the system can be used in many hospitals efficiently in the future after pilot operations.
Diagnosis ; Korea ; Nursing Diagnosis* ; Nursing Process ; Nursing Records ; Nursing*

PURPOSE: The purpose of this study was to determine the concept of critical thinking and clinical reasoning and to propose a strategy to improve clinical reasoning for oncology nurses. METHODS: A literature review was used. The concept of clinical reasoning and critical thinking in nursing was reviewed. Results of research of its area in Korea was evaluated. RESULTS: A summary of the literature review for critical thinking, clinical reasoning, and research of critical thinking in clinical nurse in Korea was described. The concept of clinical reasoning was not established in nursing and thirteen articles were reported from 2000 to 2014 in Korea. CONCLUSION: Several strategies to improve the clinical reasoning in oncology nursing setting were proposed. First, personal effort to develop thought ability by using good questions. Second, nursing administration should offer support to the oncology unit to relieve the burden and to change the nursing delivery system to fit the oncology unit. Finally, nursing school has to teach teach critical thinking in the junior grade and develop clinical reasoning ability in the senior grade of clinical practice. it is necessary to teach not only the right practices but also the right questions and reasoned thinking to novice nurses during training by preceptors.
Humans ; Korea ; Nursing ; Nursing Process ; Oncology Nursing ; Schools, Nursing ; Thinking

PURPOSE: This study was done to identify the Domains, Classes, labels and nursing activities of nursing interventions used with 117 patients who were admitted to orthopedic nursing units. METHOD: Data were collected in January and February, 2004 using a computerized nursing process program that contained nursing diagnosis-outcome-intervention (NNN) linkages. The program was developed by the researcher. Frequencies and percentages were used in the analysis. RESULTS: Sixty-five nursing intervention labels were identified. The Domains of the nursing interventions showed higher percentages for 'physiological: basic' (75.9%), 'physiological: complex' (12.9%), 'behavioral' (7.8%) 'family' (1.3%), and 'safety' (1.1%). The Classes of nursing interventions showed higher percentages for 'activity and exercise management' (30.8%), 'physical comfort promotion' (19.3%), 'immobility management' (14.5%), 'drug management' (8.1%), and 'coping assistance' (5.6%). Nursing intervention labels showed higher percentages for 'pain management' (14.7%), 'body mechanics promotion' (8.0%), 'exercise therapy : ambulation' (7.2%), 'splinting' (5.4%), and 'positioning' (5.1%). In the comparison of numbers between performed nursing activities and nursing activities of NIC according to nursing intervention label, the mean of combined rate was 52.3%. CONCLUSION: These findings will help in building of a standardized language for orthopedic nursing units and enhance the quality of nursing care.
Humans ; Mechanics ; Nursing Care ; Nursing Process ; Nursing* ; Orthopedic Nursing* ; Orthopedics*

PURPOSE: The purposes of this study were to analyze the core nursing interventions that are used in the medical and surgical units, and to present the basic data that can be applied in clinical fields. METHOD: The data was collected from 353 nurses of the medical and surgical units from Jan. 2005 to Dec. 2005, using the database of nursing process record system used at a tertiary hospital. RESULTS: 190 interventions were performed in the medical units, with 21 core nursing interventions. 198 interventions were performed in the surgical units, with 16 core nursing interventions. There were 11 common core nursing interventions. CONCLUSION: The results revealed that the ratio of physiological interventions and the interventions related to safety were high. The interventions were classified according to one's field of specialization, together with the common interventions were also being performed. According to the changes in the demands of consumers, there was also increases in the performance of 'pain management' and 'fall prevention.' We expect that this study will allow for the performance of standardized interventions, and that it will be helpful in the role of the experienced nurse, and in the approach to the nursing specialty.
Nursing Process ; Nursing* ; Specialties, Nursing ; Tertiary Care Centers*

PURPOSE: The purpose of this study was to investigate the effects of preclinical clinical performance examination (CPX) on nursing students' confidence in their nursing skills and critical thinking competence. METHODS: The design of this research was one-group pretest-posttest, and the participants were 112 nursing students. The preclinical CPX consisted of a clinical examination, patient-nurse relationship, oral test of related knowledge, written test of the nursing process, and debriefing using comprehensive scenarios based on real patient cases. The confidence of nursing skills consisted of an 8-item NRS and the critical thinking competence consisted of a 12-item 4-point scale developed by researchers and measured in both the pretest and posttest. The collected data were analyzed using paired t-tests, ANOVA, and Pearson correlation coefficients. RESULTS: The score for confidence in nursing skills (t=10.60, p<.001) and that for critical thinking competence (t=7.03, p<.001) increased significantly after preclinical CPX. CONCLUSION: This study showed that preclinical CPX was effective in improving nursing students' confidence in their nursing skills and critical thinking competence. Therefore, preclinical CPX is expected to be utilized in nursing practice education. Additional studies including those on control groups are recommended to compare differences between the preclinical CPX group and control group.
Education ; Humans ; Mental Competency* ; Nursing Process ; Nursing* ; Students, Nursing ; Thinking*

OBJECTIVES: The objective of this study is to compare nursing records before and after the implementation of an electronic nursing records system. METHODS: Twenty patients' paper-based nursing records and 20 patients' electronic nursing records were analyzed according to the nursing process and compared in terms of quantity and quality. RESULTS: In terms of quantity, the average number of statements documented per patient per day has increased by 2.5 times, from 10.3 to 25.6 statements. The average number of redundancies of a unique statement also has increased by 67%, from 5.0 to 8.8. As for the content of nursing records, paper-based nursing records have more patient problem statements describing signs and symptoms, nursing observations, and patient status. Electronic nursing records have more nursing activity statements. In terms of quality, there were more nursing records following patterns of nursing process in electronic nursing records than paper-based nursing records. The electronic nursing records have a more detailed documentation compared to the paper-based nursing records. CONCLUSION: After the implementation of electronic nursing record system, quantity of nursing records and the pattern of nursing records following the nursing process have been increased and granularity of nursing records has been improved.
Humans ; Nursing ; Nursing Process ; Nursing Records* ; Thoracic Surgery*

The purpose of this study was to develop and to evaluate the Computerized Nursing Diagnosis/ Intervention System for Nutritional and Eliminative Problems for clinical application. Each stage was processed based on the System Development Life Cycle. At the Strategy Planning Stage, valid nursing diagnoses and interventions were chosen. At the System Analysis Stage, a nursing diagnosis and intervention flowchart was drawn up. At the System Design Stage, a system was developed based on the flowchart and named the Nursing Diagnosis/Intervention System. The Nursing Diagnosis/Intervention System consisted of the Patient's Basic Information, Patient's Nursing Process, Nursing Process, and Code Registration. Each element in flowchart was coded and made into a database. The System was used and evaluated. A total of 30 cases were collected. After the application, the nurses evaluated the System using a 5 point Likert scale. Every item was scored at three points or more and 13 out of 17 items were scored at four points or more, thus the Nursing Diagnosis/Intervention System that was developed in this study was regarded as a useful one.
Life Cycle Stages ; Nursing Diagnosis ; Nursing Process ; Nursing* ; Software Design