Dorothy Anne Jones

Background/Objectives: Nursing assessment frameworks play a critical role in guiding holistic patient evaluations, standardizing documentation, and supporting organizational quality and safety initiatives. Among these, Gordon’s Functional Health Patterns (FHPs) offer a comprehensive and widely used framework for nursing assessment. However, no review has synthesized evidence on their association with outcomes. This scoping review aimed to map evidence on the use of FHPs in relation to patient and organizational outcomes, and to examine their integration into electronic health records (EHRs) and the analytical methods employed. Method: A scoping review was conducted following Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, CINAHL, and Scopus were searched for quantitative primary studies reporting associations between FHPs and outcomes, and the final search was conducted on 22 March 2024. Three reviewers independently screened abstracts and full texts and extracted data. Results: Seven studies met the inclusion criteria. FHPs’ use was associated with improvements in several patient outcomes, including quality of life, psychological well-being, clinical parameters, self-management, dependency level, and functional performance. Organizational outcomes included reduced hospital readmission rates and a positive association between FHP-derived nursing diagnoses and nursing workload. Most studies used standardized nursing terminologies such as NANDA-I, NOC, or NIC, in conjunction with FHPs. Over half of the studies used EHR-based nursing documentation, reflecting increasing digital integration and enabling more structured and interoperable nursing data. Methodological approaches varied widely: most studies used associative analyses, two employed experimental designs, and one investigated the predictive utility of FHP-based assessment data. Conclusions: FHPs provide a structured framework for nursing practice with potential benefits for patient and organizational outcomes. Their increasing integration into EHRs supports standardized documentation and data-driven nursing practice, enhancing assessment quality, diagnostic accuracy, and the availability of structured data for clinical and managerial decision-making in health information systems. Further experimental and longitudinal research is needed to strengthen causal evidence and guide implementation.

Purpose: To verify the association of the nursing diagnosis (ND) Ineffective Health Self-Management (IHS) (00276) with severe radiodermatitis in individuals with anal and/or rectal canal cancer. Methods: Cohort study, secondary to a clinical trial. Data were extracted from 57 participants undergoing radiotherapy (RT) for anal and/or rectal cancer so that a panel of experts could assess the presence of the defined characteristics and the ND of IHS. Descriptive and inferential statistical analysis was performed. Univariate analyses and bivariate analyses were applied using Fisher's exact test and chi-square test. Findings: The ND had a high prevalence. There was an association among participants with three or more defining characteristics (DC) of that diagnosis in patients experiencing severe radiodermatitis. Conclusions: An association was identified between the presence of three or more DC in the onset of severe radiodermatitis in individuals with anal and/or rectal canal cancer. Implications for nursing practice: The study contributes to incorporating the association between a human response and an adverse event in the nursing standards or guidelines related to the context of RT.

Purpose: To clinically validate the NANDA International (NANDA-I), nursing diagnoses (ND) of “Ineffective breastfeeding (00104)” and “Readiness for enhanced breastfeeding (00106)” in postpartum women and their infants, and to determine the sensitivity, specificity, and predictive value of their elements. Methods: Cross-sectional study was conducted from June 2023 to April 2024. Recruitment happened at a public teaching hospital, approaching dyads from the neonatology outpatient clinic and the rooming-in. The researcher applied the tool, assessed the dyad and medical records. Statistical analysis was based on accuracy measures and inferential statistics. The study was approved by the Ethics Committee. Findings: The sample comprised 205 Brazilian dyads: 57 (27.80%) presented “Ineffective breastfeeding (00104),” whereas 203 (99.02%) presented the “Readiness for enhanced breastfeeding (00106).” “Unsustained sucking on the breast” was the most sensitive defining characteristic (DC) for the “Ineffective breastfeeding (00104).” All the DCs of “Readiness for enhanced breastfeeding (00106)” showed relevant sensitivity. Conclusions: Findings validated the presence of NANDA-I ND “Ineffective breastfeeding (00104)” and “Readiness for enhanced breastfeeding (00106)” in a sample of dyads, demonstrating accuracy in such population. Implications for nursing practice: This is an essential step to raise the level of evidence of the studied ND from NANDA-I terminology. Furthermore, this study has potential to contribute to improving nurse's clinical reasoning on breastfeeding, as well as to highlight that women can present simultaneously the two diagnoses, so naming them is useful to identify mothers more likely to breastfeed and those who will need more differentiated interventions.

Purpose: To review and validate the elements of the nursing diagnosis (ND) “Insufficient breast milk production” (00216) based on the literature and expert consensus, and to construct operational definitions (ODs) for its defining characteristics (DCs). Methods: It is a methodological study carried out in two phases. In the first phase, a scoping review was conducted, and in the second, a committee of experts reviewed the elements’ content. Items with a Content Validity Index ≥0.8 were validated for relevance, clarity, and precision. Discussions were conducted until a consensus was reached on all items and criteria evaluated. The Ethics Committee approved the study. Findings: The final scoping review sample consisted of 61 articles, and 19 experts evaluated the content of the ND. All DCs were revised. Three at-risk populations, three associated conditions, and one related factor were added. Three elements had their category changed, and an element was deleted. Experts also validated ODs developed for all DCs. Conclusion: “Insufficient breast milk production (00216)” was validated by experts. This study improved the ND through literature and expert consensus. New elements were added, and existing ones were revised. Implications for nursing practice: This study improves this ND based on scientific evidence and clinical expertise and potentially improves nurses’ diagnostic accuracy through ODs.

Background/Objectives: Standardized nursing terminologies (SNTs) have been associated with improved patient and organizational outcomes. This secondary analysis aims to examine how structured nursing assessment data and documentation are integrated into electronic health records (EHRs) in studies that report on the impact of American Nurses Association–recognized SNTs. Methods: Data were extracted from all 53 primary studies included in a previously published systematic review. The original literature search was conducted in PubMed, Scopus, CINAHL, and OpenGrey. Extracted data focused on nursing assessment tools, use of EHRs, inter-rater reliability, and methodological characteristics. Results: Gordon’s Eleven Functional Health Patterns was the most frequently used nursing assessment framework, often in combination with NANDA-I diagnoses. However, details regarding assessment tools and their application in EHRs were inconsistently reported. Only about one-third of the studies explicitly indicated the use of EHRs, though an upward trend in their use has been observed over the last decade. Inter-rater reliability was reported in a limited number of studies, with considerable variation. An overall increasing trend in the use of nursing assessment data in electronic health records was observed over the past decade. Conclusions: The integration of SNTs with structured assessment frameworks into EHRs is increasing but remains inconsistently reported. Standardized documentation practices could strengthen nursing visibility, support quality improvement, and enhance outcome measurement in both clinical and research contexts.

Purpose: To verify the association of the nursing diagnosis (ND) Ineffective Health Self‐Management (IHS) (00276) with severe radiodermatitis in individuals with anal and/or rectal canal cancer. Methods: Cohort study, secondary to a clinical trial. Data were extracted from 57 participants undergoing radiotherapy (RT) for anal and/or rectal cancer so that a panel of experts could assess the presence of the defined characteristics and the ND of IHS. Descriptive and inferential statistical analysis was performed. Univariate analyses and bivariate analyses were applied using Fisher's exact test and chi‐square test. Findings: The ND had a high prevalence. There was an association among participants with three or more defining characteristics (DC) of that diagnosis in patients experiencing severe radiodermatitis. Conclusions: An association was identified between the presence of three or more DC in the onset of severe radiodermatitis in individuals with anal and/or rectal canal cancer. Implications for nursing practice: The study contributes to incorporating the association between a human response and an adverse event in the nursing standards or guidelines related to the context of RT.

Objetivo: someter a prueba la estructura factorial, confiabilidad y validez convergente del instrumento Functional Health Pattern Assessment Screening Tool – Versión modificada para Brasil. Método: evaluación psicométrica del instrumento Functional Health Pattern Assessment Screening Tool – Versión modificada para Brasil. Setecientos diecisiete participantes respondieron el instrumento de recolección de datos, compuesto por dos partes. La Parte I incluyó un cuestionario estructurado para recopilar datos sociodemográficos y las percepciones y el nivel de satisfacción de los participantes con respecto a su estado de salud actual. La Parte II consistió en la herramienta sometida a prueba. La estructura interna se evaluó empleando Análisis Factorial Confirmatorio. La validez interna se evaluó por medio de la correlación entre las puntuaciones obtenidas en la herramienta y los índices correspondientes a los niveles de autopercepción y satisfacción con respecto al estado de salud actual. La confiabilidad se evaluó utilizando el coeficiente alfa de Cronbach. Resultados: el Análisis Factorial Confirmatorio confirmó una solución con tres factores. Las cargas factoriales fueron significativas y variaron entre 0,16 y 0.75; los índices de ajuste sugirieron ajuste moderado del modelo. La consistencia interna correspondiente a los tres componentes varió entre 0,779 y 0,919. Conclusión: los hallazgos sugieren que la herramienta es válida y confiable para ser usada en la población de Brasil, aunque se recomienda interpretar los resultados con precaución debido al moderado ajuste del modelo.

Objective: to test the factorial structure, reliability and convergent validity of the Functional Health Pattern Assessment Screening Tool – Modified Brazilian Version. Method: this was a psychometric evaluation of the Functional Health Pattern Assessment Screening Tool – Modified Brazilian Version. Seven hundred and seventeen participants answered the data collection instrument consisting of two parts. Part I included a structured questionnaire to collect sociodemographic data and the participants’ perceptions and satisfaction with their current health status. Part II consisted of the tool being tested. The internal structure was assessed using Confirmatory Factor Analysis. Convergent validity was evaluated by the correlation of the tool scores with the rates corresponding to self-perception and satisfaction with current health status. Reliability was assessed using Cronbach’s alpha. Results: the Confirmatory Factor Analysis confirmed a three-factor solution. The factor loadings were significant and varied from 0.16 to 0.75; the fit indices suggested moderate fit of the model. Internal consistency for all three components varied between 0.779 and 0.919. Conclusion: the findings suggest that the tool is valid and reliable to be used in the Brazilian population, although caution is recommended when interpreting the results due to the moderate fit of the model.

Objetivo: testar a estrutura fatorial, a confiabilidade e a validade convergente do Functional Health Pattern Assessment Screening Tool – Versão Brasileira Modificada. Método: avaliação psicométrica do Functional Health Pattern Assessment Screening Tool – Versão Brasileira Modificada. Setecentos e dezessete participantes responderam os itens do instrumento de coleta de dados composto por duas partes. A Parte I incluiu um questionário estruturado contendo dados sociodemográficos e a percepção e satisfação dos participantes com seu estado de saúde atual. A Parte II consistiu no instrumento testado. A estrutura interna foi avaliada por meio de Análise Fatorial Confirmatória. A validade convergente foi avaliada pela correlação dos escores do instrumento com os índices correspondentes à autopercepção e à satisfação com o estado de saúde atual. A confiabilidade foi avaliada pelo alfa de Cronbach. Resultados: a Análise Fatorial Confirmatória confirmou uma solução de três fatores. As cargas fatoriais foram significativas e variaram de 0,16 a 0,75; os índices de ajuste sugeriram ajuste moderado do modelo. A consistência interna dos três componentes variou entre 0,779 e 0,919. Conclusión: os achados sugerem que o instrumento é válido e confiável para ser utilizado na população brasileira, embora seja recomendada cautela na interpretação dos resultados devido ao ajuste moderado do modelo.

Computer-based technologies have been widely used in nursing education, although the best educational modality to improve documentation and nursing diagnostic accuracy using electronic health records is still under investigation. It is important to address this gap and seek an effective way to address increased accuracy around nursing diagnoses identification. Nursing diagnoses are judgments that represent a synthesis of data collected by the nurse and used to guide interventions and to achieve desirable patients' outcomes. This current investigation is aimed at comparing the nursing diagnostic accuracy, satisfaction, and usability of a computerized system versus a traditional paper-based approach. A total of 66 nursing students solved three validated clinical scenarios using the NANDA-International terminologies traditional paper-based approach and then the computer-based Clinical Decision Support System. Study findings indicated a significantly higher nursing diagnostic accuracy (P < .001) in solving cancer and stroke clinical scenarios, whereas there was no significant difference in acute myocardial infarction scenario. The use of the electronic system increased the number of correct diagnostic indicators (P < .05); however, the level of students' satisfaction was similar. The usability scores highlighted the need to make the electronic documentation systems more user-friendly.