The association between nursing diagnoses, resource utilisation and patient and caregiver outcomes in a nurse-led home care service: Longitudinal study

摘要

Background: The information generated by nurses through standardised nursing languages is insufficiently evaluated andexploited, mainly in home care services, as is its potential impact on outcomes.Objectives: To find out how often nursing diagnoses are made during nursing home care visits, and to explore their relation withuse of resources, mortality, institutionalisation and satisfaction.Design: Observational, longitudinal follow-up study.Settings: Home care services delivered by Primary Healthcare Districts in Malaga, Costa del Sol, Almeria and Granada, inSpain.Participants: Patients and caregivers who initiated the Home Care Programme.Methods: The accumulated incidence of nursing diagnosis was analysed over 34 months of follow-up. Diagnoses were made bynurse case managers in their daily practice. Several regression models were devised to analyse their linkage with the use ofresources, mortality, institutionalisation and satisfaction.Results: Two hundred and forty-seven subjects were included (129 patients and 118 caregivers). 93.8 had been diagnosed (2.8diagnoses per subject). Risk of caregiver strain and mobility impairment accounted for 40% of total home visits (p = 0.033).Significant differences were observed in the use of physiotherapy and rehabilitation services. The home visits for caregiverswere, in 78% of cases, due to the recipient's baseline functional status. No relation was detected for institutionalisation or forpatient satisfaction. There was a higher rate of anxiety diagnosed in the caregiver when the recipient was at greater risk formortality (RR: 2.08 CI 95%: 1.26-3.42) (p = 0.012).