A Thesis Presented for the Philosophy Degree in Nursing Development of a System for using Nursing Diagnoses in the Clinical Settings: Participatory Action Research

Abstract

Abstract: Introduction: Nurses in burn patients must have high knowledge of post-burn physiological and psychological changes, accurate assessment skills to determine minor changes in patient status, rehabilitation, the ability to communicate effectively with the patient, family, and other multidisciplinary teams of the burn. These abilities lead to the high quality of care and increase the chances of patient survival and better quality of life for patients. Given the increasing number of patients complaining of poor nursing care in burn wards, increased hospitalization and mortality of burn patients, low effectiveness in nursing care and incomplete nursing documentation system; this study was performed aimed to improve nursing care and documentation in male and female burns wards. Material & Methods: This study was conducted as a participatory action research method for 20 months in 2018-2019. Participants in this study were nurses, nursing services manager, clinical and educational supervisors, and the research team. Focused group discussions, individual interviews, and numerous observations after reviewing the literature and identifying the strategies used in Iran and the world in assessing health status and nursing diagnoses. All recorded conversations were transcribed verbatim and the results analyzed in reflection sessions. Based on the objectives of the reflection sessions, the electronic form and the pen-paper form were designed to assess health status and nursing diagnoses and were performed experimentally in burn wards. Results: In this study, first, nursing diagnoses in burn wards were extracted according to the latest nursing guidelines, and then for each nursing diagnosis, objective and subjective symptoms were determined based on the nursing reference book and approved in reflection sessions. All signs and symptoms were included in accordance with Gordon's functional health patterns with 13 domains. These templates were provided both in software and in paper form. After testing both methods in burn and defect correction sections, with the approval of the Hospital Medical Records Committee, the pen-paper form was attached to the patient's records. Conclusion: With the use of these two methods by nurses, due to their rich scientific content, the level of knowledge of nurses about patient problems was improved, nurses' communication with patients improved, and nursing documentation was improved.