Análisis de concordancia sobre la declaración de las intervenciones que, bajo criterios NIC, realiza la enfermería con pacientes psiquiátricos hospitalizados

Résumé

Background: The present work seeks to ascertain the outlines of the interventions, according to NIC, that nursing displays whit the psychiatric in-patients of one hospital for acute patients. It investigates the reliability that the transmission of those interventions related with the source of declaration. Methods: The interventions displayed in a cohort of psychiatric in-patients of the University Clinical Hospital of Valencia, from January to June of 2004 (126 patients), are analysed. It is analysed the concordance between the consignment of the 67 planned NIC interventions, taking into account that the declarative source was write in the nursing observation sheets, or verbalized in the shift change or detected by means of participating observation. That concordance is analysed through the kappa index of Cohen implemented with the software Stata 8/S® for Windows®. Findings: All things detected by means of participating observation have a high concordance with the planned (I.C 95% kappa: 0'82-0'86). That concordance decline significantly and in an eloquent way for the two other informative sources. In the case of the information supported in a documental way (transcribed in the nursing observation sheets) the accuracy is very low respect to the planned (IC 95% 40'8%-42'7%), at the same time the frequency of the planned interventions that are not transcribed is very high (IC 95%, probability of false negatives: 62'1%-64'1%). Conclusions: There are an important decrease between the interventions, according to NIC, observed that nursing display with the psychiatric patients and its transcription in the nursing observation sheets or its verbal communication during the shift changes (IC 95% probability of not declared and realized: 61'5% - 63'5% y 37'3% - 39'3%, respectively). Thereby our outcomes indicate an important under declaration of the interventions transcribed and verbalized, however that interventions are displayed for the nurses to the psychiatric in-patients in the our hospitals. This situation has to be taking into account in the studies based in data obtained from that sources, it would be advisable to verify the consistence of the findings obtained in this study in other environments.