A 10-Year Retrospective Study of Teaching Nursing Diagnosis to Baccalaureate Students in Italy

International Journal of Nursing Terminologies and Classifications, Apr-Jun 2009 by Palese, Alvisa, De Silvestre, Daniele, Valoppi, Graziella, Tomietto, Marco

PURPOSE. The aim of this 10-year retrospective study was to evaluate the impact of teaching nursing process to students at different levels of baccalaureate education, using the North American Nursing Diagnosis Association International (NANDA-I) Taxonomy.

METHOD. Nursing care plans written between 1996 and 2006 by 3,784 students who had completed a baccalaureate course in nursing process at a university in northern Italy were evaluated. At least three of the four steps of the nursing process were included in the evaluation: assessing, planning, intervening, and evaluating.

RESULTS. An average of 6.3 (range 0-31; ±3.9; median 6) problems were identified in each care plan. Of these, 5.1 (range 0-29; ±3.06; median 5) were related to nursing diagnoses concerning either an actual problem or the risk of developing a problem; the remaining 1.2 (range 0-20; ±1.9; median 0) diagnoses were concerned either with collaborative problems or with potential complications. The students demonstrated significant improvement in accurately identifying 75 diagnostic titles from the NANDA-I Taxonomy as they progressed through their first, second, and third years of baccalaureate study.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE. These findings suggest that the ability to use the NANDA-I Taxonomy accurately is acquired over time. Thus, the theory and practice of using nursing process should be introduced in a formal course during the first year of baccalaureate nursing education and should be reinforced throughout the remaining courses. Students can then progressively improve their knowledge, critical thinking abilities, and use of the NANDA-I Taxonomy during their second and third years of study. Teaching strategies to reinforce students' learning are recommended.

Search terms: NANDA-I Taxonomy, nursing education, teaching nursing process

OBIETTIVI. L'obiettivo di questo studio retrospettivo, è stato quello di valutare l'impatto dell'insegnamento del Processo di Nursing basato sulla tassonomia NANDA-I realizzato negli ultimi dieci anni al primo, secondo e terzo anno di un Corso di Laurea in Infermieristica.

METHOD. Sono stati inclusi 3.784 piani di assistenza elaborati dagli studenti che hanno frequentato e concluso il Corso di Laurea in Infermieristica presso un Ospedale Universitario del Nord Italia dal 1996 al 2006. Sono in particolare state valutate tre tra le quattro fasi del Processo di Nursing che comprendono l'accertamento, la pianificazione, l'attuazione e la valutazione dei risultati sul paziente.

RISULTATI. Ciascun piano di assistenza ha riportato una media di 6.3 (range 0-31; ±3.9; mediana 6) problemi. Di questi, 5.1 (range 0-29; ±3.06; mediana 5) erano Diagnosi Infermieristiche riguardanti problemi attuali o di rischio; i rimanenti 1.2 (range 0-20; ±1.9; mediana O) riguardavano, invece, problemi collaborativi o complicanze potenziali. Gli studenti hanno dimostrato un significativo miglioramento nell'accuratezza nell'uso delle diagnosi passando dal primo al secondo e dal secondo al terzo anno di studio, utilizzando 75 titoli diagnostici dalla tassonomia NANDA-I.

CONCLUSIONI ED IMPLICAZIONI PER LA PRATICA. I risultati di questo studio suggeriscono che l'abilità di utilizzare accuratamente la tassonomia NANDA-I è acquisita nel tempo. L'apprendimento teorico e pratico del Processo di Nursing deve essere introdotto con un corso formale dal primo anno di studio e deve essere rinforzato per l'intera durata degli studi. Gli studenti possono successivamente aumentare progressivamente la conoscenza, l'abilità di pensiero critico e l'utilizzo del sistema Tassonomico NANDA-I al secondo e terzo anno di studio. Strategie di insegnamento che rinforzano l'apprendimento degli studenti sono raccomandate.

Parole chiave per la ricerca: Tassomia NANDA-I, formazione infermieristica, insegnamento del processo di nursing

Nursing education in Italy has moved to baccalaureate education in the university. Accompanying this transition has been the adoption of translated North American Nursing Diagnosis Association International (NANDA-I) classifications (Calamandrei, 1994, 2004, 2005; Carpenito, 1994, 1996, 1999, 2000) as documented in other countries (Ehrenberg, Ehnforts, & Smedby, 2001; Finesilver & Metzler, 2003; Lutzen & Tishelman, 1996; Thoroddsen & Thorsteinsson, 2002). Thus, nursing students are increasingly using standardized language in implementing the classic components of nursing process: assessing, planning, intervening, and evaluating (Alfaro, 1994; Yura & Walsh, 1988). The language adopted in the present study to describe actual problems or risk of problems in nursing diagnosis is based on the NANDA-I Taxonomy.

As documented in the literature (Flatt, 2003), nursing students in Italy are taught the nursing process in a variety of ways: in a classroom, through practical application with a simulated patient, or, most often, directly with actual patients under the supervision of an expert as a tutor in the clinical setting. Some schools request that the tutor has students use standardized care plans according to Holloway's translation (Holloway, 1993). Other schools require students to complete a grid based on phases of the nursing process and to develop individualized care plans for their patients. In some schools, the tutor decides which patients need a care plan, while in others the students decide which patients need an individualized care plan (Palese, 2002). However, since the publication of the first Italian translation of the NANDA Taxonomy (Calamandrei, 1994), there has been a national trend to introduce a specific course on nursing process in the first year of baccalaureate education (Palese & Dal Ponte, 2007a, 2007b). No formal evaluation of the impact of this trend on students' nursing care plans has been documented (Palese, 2002).