Effectiveness of standardized nursing care plans to achieve A1C, blood pressure, and LDL-C goals among people with poorly controlled type 2 diabetes mellitus at baseline: four-year follow-up study

Abstract

BackgroundNo studies that have measured the role of nursing care plans in patients with poorly controlled type 2 diabetes mellitus. Our objectives were firstly, to evaluate the effectiveness of implementing Standardized languages in Nursing Care Plans (SNCP) for improving A1C, blood pressure and low density lipoprotein cholesterol (ABC goals) in patients with poorly controlled type 2 diabetes mellitus at baseline (A1C ≥7%, blood pressure ≥ 130/80 mmHg, and low-density lipoprotein cholesterol≥100 mg/dl) compared with Usual Nursing Care (UNC). Secondly, to evaluate the factors associated with these goals.MethodsA four-year prospective follow-up study among outpatients with type 2 diabetes mellitus: We analyzed outpatients of 31 primary health centers (Madrid, Spain), with at least two A1C values (at baseline and at the end of the study) who did not meet their ABC goals at baseline. A total of 1916 had A1C ≥7% (881 UNC versus 1035 SNCP). Two thousand four hundred seventy-one had systolic blood pressure ≥ 130 mmHg (1204 UNC versus 1267 SNCP). One thousand one hundred seventy had diastolic blood pressure ≥ 80 mmHg (618 UNC versus 552 SNCP); and 2473 had low-density lipoprotein cholesterol ≥100 mg/dl (1257 UNC versus 1216 SNCP). Data were collected from computerized clinical records; SNCP were identified using NANDA and NIC taxonomies.ResultsMore patients cared for using SNCP achieved in blood pressure goals compared with patients who received UNC (systolic blood pressure: 29.4% versus 28.7%, p = 0.699; diastolic blood pressure: 58.3% versus 53.2%, p = 0.08), but the differences did not reach statistical significance. For A1C and low-density lipoprotein cholesterol goals, there were no significant differences between the groups. Coronary artery disease was a significant predictor of blood pressure and low-density lipoprotein cholesterol goals.ConclusionsIn patients with poorly controlled type 2 diabetes mellitus, there is not enough evidence to support the use of SNCP instead of with UNC with the aim of helping patients to achieve their ABC goals. However, the use of SNCP is associated with a clear trend of a achievement of diastolic blood pressure goals.

Implementing a Care Plan System in a Community Hospital Electronic Health Record

“…The literature supported the adoption of an SNL and the use of technology to support care planning. 4,13,16,33 Fortuitously, health information technology has become ubiquitous, and nursing documentation moved into the EHR. According to the Office of the National Coordinator for Health Information Technology, 96% of all nonfederal hospitals have an EHR.…”

“…12 Another research team reported diabetic patient outcomes more likely to reach hemoglobin A1C, blood pressure, and low-density lipoprotein cholesterol goals when electronic standardized nursing care plans were used (OR = 0.97; 95% confidence interval, 0.79-1.19; P = .76). 13 An observational study exploring Author Affiliation: Frederick Health Hospital, Frederick, MD.…”

“…13 Many studies supported the use of SNL in the development of individualized nursing care. [9][10][11][12][13][14][15][16][18][19][20][21][22][23][24][25] Other factors mentioned in the literature that impact the development of individualized nursing care plans includes staff training, nursing attitudes, and the use of electronic documentation. [19][20][21][22][23]…”

Challenges to sustainability of standardized nursing care plan in selected tertiary health institutions in Nigeria

“…As a result, standardized languages are required by the clinical information system to assist clinicians with nursing practice documentation (Sani & Sani, 2017). The research-based tool that is currently utilized in adult care settings in developed countries like the United States and Sweden, among others, has helped in labeling and identifying the contribu-tions of nursing to healthcare delivery systems, as well as served as clinical protocol in these settings (Cárdenas-Valladolid et al, 2018). This research-based clinical protocol is known as the SNCPs.…”

Establishing Technical Values for Nursing Diagnoses in Primary Healthcare

“…According to a recent systematic review, nursing classification systems and standardized nursing languages are crucial for the successful integration of nursing documentation into the electronic record (Johnson, Edward, & Giandinoto, ). Using the nursing process and the NANDA‐I, NIC, and NOC standardized nursing languages in the electronic patient record makes it possible to increase the visibility of nursing practice and to assess the degree of influence of nursing on the health outcomes sensitive to this practice (Cárdenas‐Valladolid et al., ; Flanagan, ), both on single discipline's outcomes, more specific outcomes, as well as on multidisciplinary, more comprehensive outcomes (Duffy, ; Moorhead, Johnson, Mass, & Swanson, ; Pérez‐Rivas et al., ).…”