Which domain of the nursing interventions classification taxonomy includes care that supports?

Step 1: Assessment

Biopsychosocial data about geriatric patients are collected by means of interviews, record reviews, direct observations and other approaches, as time allows, to build a composite picture of the multiple and often competing needs of the geriatric patient and the informal caregiver. For example, the federally mandated multidisciplinary assessment called the Minimum Data Set (Burke & Walsh 1997) is used in nursing homes by long-term care nurses to record assessment data as part of the team approach to care planning and treatment.

Data from nursing assessments are necessary to identify problems in the order of clinical significance at a specific time and according to the urgent need for nursing interventions. The information may include general and specific data on the presenting problems as defined by the patient and the caregiver, medical diagnoses, prescribed medical treatments, status of physical and mental functions, alternate healthcare resources, patient goals and expectations, safety risks, self-care abilities for recovery, including the ability to perform activities of daily living, and other information that a nurse considers clinically relevant to the case or situation. Identifying nursing diagnoses and prioritizing these problem areas are the major intended process outcomes.

Since 1973, the North American Nursing Diagnosis Association (NANDA) has continued to develop a taxonomy of nursing diagnoses, and currently there are approximately 130 approved classifications of patient care problems in nine categories. In 1987, the Center for Nursing Classification and Clinical Effectiveness at the College of Nursing, University of Iowa, developed taxonomies for classifying and organizing nursing interventions and nursing outcomes through the use of the Nursing Intervention Classification (NIC). This was followed by the development of Nursing Outcomes Classification (NOC) coding systems in 1992. The NIC/NOC codes are linked to the NANDA diagnoses and serve to document the effectiveness of nursing interventions and outcomes (McCloskey et al 2004, Moorhead et al 2004). Refinement of the NIC/NOC classification systems has been ongoing. The use of nursing taxonomies facilitates the capture of nursing data useful for evaluation, quality improvement, and research activities.

It is important for members of healthcare teams to be aware that some problem areas that demand priority nursing interventions may not always be parallel to or target directly the ‘curing’ goals of a medical plan.

Step 2: Planning

The nursing care plan incorporates specific nursing interventions and activities to treat specific nursing diagnoses or deal with problem areas such as changes in food intake, impaired capacity for personal care, risk of accidental injuries due to general weakness and mild dementia, grief unrelated to the health problem, and other needs of the geriatric patient and the caregiver. Included in the plan are nursing actions to insure the continuity of all prescribed medical treatments and other intervention modalities for the geriatric patient. Clinical judgment is an important nursing skill in this process because it enables an accurate identification of the nursing diagnosis.

Step 3: Implementation

The process of implementation utilizes the collective efforts of members of the nursing staff, including auxiliary nursing personnel, and directs them so that the nursing care plan can be carried out. Safe and compassionate approaches that are clinically and technically appropriate are used to achieve the desired clinical outcomes. Nursing actions may include activities such as checking vital signs, changing the position of an immobilized elderly patient, orienting an elder with a memory deficit to time, place, and activity, interviewing a family caregiver prior to homecare, consulting other healthcare professionals, advocating for an elder to obtain a local community resource, and other actions aimed at resolving a nursing problem or reducing the impact of a nursing diagnosis.

Step 4: Evaluation

A patient's physical, verbal and behavioral responses, informal caregivers’ reports and observations by healthcare providers from other disciplines are important aspects of the feedback mechanism that helps the nursing staff to maintain a dynamic, flexible care plan. Critical analysis of information obtained while nursing interventions are in progress may be used to modify nursing interventions, redirect patient and family participation in the overall treatment and management plan, re-examine the healthcare team's understanding of the clinical problem, determine cost benefits, realign leadership and support the standards of quality patient care.

3.3.1 Case management

Thirty-eight studies (57,193 participants) were categorised as case management, most commonly employing a parallel RCT design (n = 26). The sample size varied across studies from 20 to 49,311 participants. Most studies included 101–500 participants (n = 27). Case management studies involved adult (or older adult) participants in 37 studies; only one trial included a mixed population of people with cancer and their carers (Supplementary Table 2).

Over half of the studies in this category included participants with a range of different cancer types (classed as ‘multiple’) (n = 20) (Supplementary Table 2, Fig. 2). The majority of these studies were focused on the active phase of cancer treatment (n = 20) and end-of-life (n = 12) (Fig. 3).

The most common focus of case management interventions was the provision of supportive care or psychosocial and/or psychosexual care. Other common components of these interventions were the management of signs and symptoms, primarily emotional and continuity of care (Supplementary Table 2). Specialist oncology nurses (n = 13) or advanced cancer nurses (n = 12) delivered the majority of interventions (n = 23), however a variety of descriptors were used to document their professional roles, education and training (Supplementary Table 2, Fig. 4).

The number of contacts for delivering case management interventions were clearly reported in 23 studies and ranged from 1 to 18 contacts (face-to-face and telephone), Supplementary Fig. 5a. The length of interventions ranged widely from 1.5 to 260 weeks (Supplementary Fig. 5b). The amount of time attributed to case management interventions delivered by cancer nurses ranged from 120 to 1377 min per participant (Supplementary Table 2).

3.3.2 Surveillance

Twenty-seven studies (4892 participants) were included in the surveillance category. All of the participants were adults. Sample size ranged from 43 to 775 participants. Six studies included less than 100 participants with the majority of studies (n = 21) including between 101–500 participants.

The majority of studies in this category focused on women with breast cancer (n = 8). Over half of the interventions in 16/27 studies were delivered in the treatment phase of the cancer trajectory. However, a third of studies classed as surveillance interventions (9/27) took place in the cancer survivorship phase. The descriptions of components involved interventions aimed at assessment, managing signs and symptoms, encouraging self-management and supportive care.

Specialist nurses delivered the majority of surveillance interventions; however once again a variety of descriptors were used to document their professional education and training (Fig. 4, Supplementary Table 3).

All of the interventions were delivered on a 1-to-1 basis. Most studies included face-to-face and telephone contact; 8 were telephone interventions only (no face-to-face contact) and 4 had additional e-health/computer delivered components. Interventions were mainly delivered in an outpatient or home based environment. The intervention regime varied across studies from 1 to 25 sessions; total amount of time attributed to the interventions ranged from 30 to 675 min. (n = 14 studies) and was delivered over 1 week–260 weeks (Supplementary Figs. 5a–b, Supplementary Table 3).

3.3.3 Teaching, guidance and counselling

The majority of studies were categorised as teaching, guidance and counselling (n = 131; 182,075 participants). Although most of the studies were conducted with adults, 15/131 had a mixed population, including people with cancer and their partners (n = 9/16), or people with cancer and Health Care Personnel (HCP – 6/16); 1/16 included family members, HCP and people with cancer. Five studies in this category included children and young people as participants. The sample size across all studies ranged from 18 to 138,392 participants, with most studies ranging between 101–500 participants (n = 62). Studies on screening recruited the highest number of participants. The interventions in this category were delivered to people with multiple types of cancer (n = 45) but women with breast cancer (n = 34) and men with prostate cancer (n = 13) also received teaching, guidance and counselling interventions (Fig. 2). Interventions in this category were delivered across the entire cancer care continuum with the majority delivered in the treatment phase of the cancer trajectory (86/131) (Fig. 3).

The main components of the interventions delivered in this category comprised of education and provision of psychosocial and psychosexual support or helping people with cancer manage symptoms (e.g. pain management, fatigue). Other interventions focused on exercise, genetics and activities aimed at promoting self-management and self-care (Supplementary Table 4).

Although cancer nurses delivered the majority of interventions; details reporting their education and training were often vague, describing nurses as “experienced’ or “trained’; with details of education unreported in over a third of studies (n = 52/131) (Supplementary Table 4).

Where reported most interventions were provided in broadly similar settings to those described in other intervention categories. Most interventions were provided on an individual and face-to-face basis; although a number of trials delivered the intervention in a group setting. Intervention regime varied across studies from 1 to 18 sessions (or contacts); total amount of time attributed to the interventions ranged from 3 to 1260 min delivered over 1 week to 104 weeks.

3.3.4 Treatment and procedures

Eighteen studies (3390 participants) were included in the treatment and procedures OMAHA category. The majority of studies were conducted with adults (n = 14); 3 studies included children and young people only. Sample size varied across studies from 7 to 844 participants. The majority of studies (11/18) included less than 100 participants. Five out of the eighteen trials included participants with a range of different cancer types (i.e. interventions were delivered to ‘multiple’ disease groups) (Supplementary Table 5). Interventions in 15/18 studies were delivered in the treatment phase of the cancer trajectory.

The main components of the interventions delivered in this category comprised screening procedures (e.g. endoscopy or colonoscopy), interventions targeting signs and symptoms in people affected by cancer using techniques such as massage, Hickman line insertions or decision algorithms. Other interventions focused on medication administration (Supplementary Table 5) and activities aimed at improving physical care including exercise and lymphatic drainage in women with breast cancer. Specialist cancer nurses delivered the intervention in 4 studies, but the education and training details in the majority of this category (n = 10) were unclear (Fig. 4).

Most interventions were provided on an individual and face-to-face basis. Where reported, the interventions were provided primarily in the hospital setting and were delivered in single session (n = 9). However, the amount of time attributed to the interventions varied widely across studies from a single (brief 15 min) intervention to more time intensive intervention of 21 sessions delivered over 72 weeks (Supplementary Figs. 5a–b).