Correlation and Regression StudyBackground During this week .docx

Correlation and Regression Study
Background
During this week you will identify a research question created
in Week 1 for which correlation or regression would be the best
statistical approach to take. If you do not have a research
question that indicates correlation or regression, review the
research questions posted by your peers last week and select
one that is ideal for correlation or regression.
Discussion Assignment Requirements
Initial Posting – In your initial posting for this assignment,
include the following:
•Identify an appropriate research question that would require
the use of correlation and regression to answer.
•Describe why this question is appropriate for a correlational
study.
•Identify the two variables in this study and each of their
attributes: discrete or continuous, quantitative or categorical,
and scale of measurement (nominal, ordinal, interval, or ratio).
•Do the variables fit the qualifications of a correlational study?
Explain.
•What type of correlation would you expect to find for this
study (i.e., positive or negative)? Explain.
•What predictions might you be interested in making with these
variables if the correlation is found to be significant?
Article Critique: Correlation & Regression
The readings for this week focus on the concepts of correlation
and regression. In this discussion we will apply those concepts
to the review and critique of Wagenheim & Anderson (2008).
For information on how to critique a research article, see the
Coughlan et al. (2007) from your resources in Week 1 and UIS
(n.d.) from your resources in Week 2.
In the body of your posting, include an overview of the

following topics:
•Research question – State the research question for the study.
•Methods and study design – Describe the basic methods used,
including the variables, sampling methods, data collection, etc.
•Data analysis – Summarize the statistical tests conducted, the
results obtained from each test, and the conclusions regarding
the research question.
•Critique – Critique the results of the study, paying specific
attention to the appropriateness of the analyses conducted, any
biases or assumptions that were made, practical significance of
the results, and recommendations for improving upon the study
(methods or analyses).
•Summary – Provide a brief summary of the study's findings in
2-3 sentences. Do not use any numbers or statistical terms, but
provide a review that would make sense to someone who has not
studied research methods or statistics.
Be sure to put information in your own words and to cite
appropriately. Respond substantively to at least two of your
classmates’ postings. Specifically, focus on their critique of the
results and discussion of the analysis. Do you agree with their
assessment? What questions did the study leave you with? How
might you have done this study differently? What do you see as
the limitations of the study as compared to your classmates?
Z, T, or Chi-Square Test Study
Background
in Week 1 that would be best answered by any of the following
statistical tests: z test, t test for single sample, independent
samples t test, repeated measures t test, or Chi-Square test. This
discussion will help you work towards your “Week 3
Assignment 2.” If there are no research questions that fit any of
these types of statistical analyses, decide on a new question
before moving forward with the assignment.

the use of a z-, t-, or Chi-Square test to answer. Pick the
question from the list created in Week 1 or identify a new
question if there are no appropriate ones from Week 1.
•Describe why this question is appropriate for the selected
statistical test.
•Identify the variables in this study and each of their attributes:
discrete or continuous, quantitative or categorical, scale of
measurement (nominal, ordinal, interval, or ratio), and
independent or dependent.
•Explain how the variables do or do not fit the qualifications for
the selected statistical test.
•Provide a written explanation for the null and alternative
hypotheses.
•Describe the types of errors that could occur.
Replies - Though you may respond to your peers multiple times
during the week to provide support or feedback, students are
required to respond to at least two of their classmates’ postings
by Day 7.
Article Critique: Chi-Square Test
The readings for this week focus on the concepts of z tests, t
tests, and Chi-Square tests. In this discussion we will apply
those concepts to the review and critique of a research article.
For information on how to critique a research article, see the
Coughlan et al. (2007) and UIS (n.d.) guides listed in the
Required Readings for this week.
Read the following article:
•Apostolou, M. (2010). Parental choice: What parents want in a
son-in-law and a daughter-in-law across 67 pre-industrial

societies. British Journal of Psychology, 101, 695-704. doi:
10.1348/000712609X480634
following topics:
•Research question – State the research question for the study.
•Hypotheses – Provide written explanations for the null and
alternative hypotheses for the study.
•Methods and Study Design – Describe the basic methods used,
•Data Analysis – Summarize the statistical tests conducted, the
results obtained from each test, and conclusions regarding the
hypotheses.
Be sure to put information in your own words and cite
accordingly. Respond to at least two of your classmates’
postings.
Basic ANOVA Study
Background
in Week 1 that would utilize one of the following: one-way
ANOVA or repeated measures ANOVA. This discussion will
help you work towards your “Week 4 Assignment 1”. If there
are no research questions that fit any of these types of statistical
analyses, you will need to decide on a new question before

moving forward with the assignment.
the use of a one-way or repeated measures ANOVA to answer.
Pick the question from the list created in Week 1 or identify a
new question if there are no appropriate ones from Week 1.
statistical test.
•Do the variables fit the qualifications for the selected
statistical test? Explain.
•List the statistical notation and written explanation for the null
and alternative hypotheses.
required to respond to at least two of their classmates’ postings
by Day 7.
Article Critique: Repeated Measures ANOVA
The readings for this week focus on the concepts of basic
ANOVAs, including one-way and repeated measures ANOVA.
In this discussion we will apply those concepts to the review
and critique of a research article. For information on how to
critique a research article, see the Coughlan et al. (2007) and
UIS (n.d.) guides listed in the Required Readings for this week.
Read the following article.
•Lee, M., & Johnson, T. E. (2008). Understanding the effects of

team cognition associated with complex engineering tasks:
Dynamics of shared mental models, Task-SMM, and Team-
SMM. Performance Improvement Quarterly, 21 (3), 73-95. doi:
10.1002/piq.20032
following topics:
•Research question – List the research question for the study.
•Hypotheses – List the statistical notation and written
explanations for the null and alternative hypotheses for the
study.
hypotheses.
(methods or analyses). • Summary – Provide a brief summary of
the study's findings in 2-3 sentences. Do not use any numbers or
statistical terms, but provide a review that would make sense to
someone who has not studied research methods or statistics.
accordingly. Respond to at least two of your classmates’
postings.
Complex ANOVA Study
Background
in Week 1 that would utilize one of the following: factorial
ANOVA or mixed-design ANOVA. If there are no research
questions that fit any of these types of statistical analyses, you

will need to decide on a new question before moving forward
with the assignment.
Initial Posting - In your initial posting for this assignment,
the use of a factorial or mixed-design ANOVA to answer. Pick
the question from the list created in Week 1 or identify a new
question if there are no appropriate ones from Week 1.
statistical test.
•Do the variables fit the qualifications for the selected
statistical test? Explain.
•List the statistical notation and written explanation for the null
and alternative hypotheses.
required to respond to one of their classmates’ postings by Day
7.
Article Critique: Factorial ANOVA
The readings for this week focus on the concepts of complex
ANOVAs, including factorial and mixed-design ANOVA. In this
discussion we will apply those concepts to the review and

critique of a research article. For information on how to critique
a research article, see the Coughlan et al. (2007) and UIS (n.d.)
guides listed in the Required Readings for this week.
Read the following article.
•Hoyt, C. L., Price, T. L., & Emrick, A. E. (2010). Leadership
and the more-important-than-average effect: Overestimation of
group goals and the justification of unethical behavior.
Leadership, 6(4), 391-407. doi: 10.1177/1742715010379309
following topics:
•Research question – List the research question for the study.
•Hypotheses – List the statistical notation and written
explanations for the null and alternative hypotheses for the
study.
hypotheses.
•Be sure to put information in your own words and cite
accordingly.
Research Consumers

While your application and evaluation of research design and
statistics in this course has been in the context of peer-reviewed
journal articles and research, most of the research you will
encounter outside of your formal studies will be in the context
of lay sources – newspapers, popular press, Facebook
threads/posts, cable news shows and so on. What are the
differences between peer-reviewed, academic research, and
research reported in the popular press? How do you go about
being an intelligent consumer of research in the popular press?
If you were to advise friends and family about how to interpret
research claims they encounter in their daily lives, what advice
would you share and why?
accordingly.
MSN5250 Group Project Part A
Critique Scoring Rubric
Group Name:
Adapted from: Oral Presentation Rubric - ReadWriteThink.
(n.d.). Homepage - ReadWriteThink.
Retrieved June 11, 2018 from
http://www.readwritethink.org/classroom-
resources/printouts/oral-
presentation-rubric-30700.html

CATEGORY 4 3 2 1 Points
Content
(x5)
Demonstrates full
knowledge of the
critique process.
Provides clear
explanations of all
critique elements;
supports
conclusions/ideas
with evidence from
the study.
Provides both
positive and
negative critique.
Demonstrates
good
understanding of
the critique
process. Provides
explanations of
majority of critique
elements; partially
supports
conclusions/ideas
with evidence from
the study.
Provides some
positive mixed
with mostly
negative critique.

Demonstrates
limited
understanding of
the critique
process. Provides
explanations of
some of critique
elements; limited
support of
conclusions/ideas
with evidence from
the study.
Provides mostly
negative critique.
Demonstrates little
to no
understanding of
the critique
process. Does not
provide
explanations of
critique elements;
does not support
conclusions/ideas
with evidence from
the study.
Provides only
negative critique.
Organization

Information is well-
organized.
Presentation flows
nicely.
Information is
organized.
Presentation flows
fairly well.
Information is
fairly organized.
Presentation does
not flow well.
Information
appears to be
disorganized.
Presentation is
difficult to
understand.
Critical
Analysis
Analyses and
conclusions are
accurate, detailed,
insightful, valid,
and consistent
with data.
Analyses and
conclusions are
consistent with

data.
Analyses and
conclusions are
mostly correct.
Analyses and
conclusions are
unclear or
inaccurate.
Comprehension
Able to accurately
answer almost all
questions posed
by colleagues
about the topic.
Able to accurately
answer most
questions posed
by colleagues
about the topic.
Able to accurately
answer a few
questions posed
by colleagues
about the topic.
Unable to
accurately answer
questions posed
by colleagues

about the topic.
Preparedness
Completely
prepared and has
obviously
rehearsed.
Well- prepared
and rehearsed.
Somewhat
prepared but it is
clear that
rehearsal was
lacking.
Does not seem at
all prepared to
present.
Timing
Presentation is
18-20 minutes
long.
Presentation is 15-
17 minutes long.
Presentation is 12-
14 minutes long.

Presentation is
less than 12
minutes or greater
than 20 minutes.
Group Member
Participation
Consistently
participated in in
development of
the project
Frequently
participated in in
development of
the project
Sometimes
participated in in
development of
the project
Never participated
in development of
the project
A retrospective study of nursing diagnoses, outcomes, and
interventions for patients with mental disorders

Paula Escalada-Hernández, PhD, MSc a,⁎, Paula Muñoz-
Hermoso, BSc b, Eduardo González–Fraile, Msc, BSc c,
Borja Santos, Msc, BSc d, José Alonso González-Vargas, PMH
CNS, BSc e, Isabel Feria-Raposo, PMH CNS, BSc f,
José Luis Girón-García, PMH CNS, BSc g, Manuel García-
Manso, BSc h THE CUISAM GROUP 1
a Public University of Navarre, Pamplona, Spain
b Clínica Psiquiátrica Padre Menni, Pamplona, Spain
c Instituto de Investigaciones Psiquiátricas, Bilbao, Spain
d Universidad del País Vasco, Bilbao, Spain
e Complejo Asistencial Hermanas Hospitalarias, Málaga, Spain
f Benito Menni CASM, Sant Boi, Spain
g Centro Neuropsiquiátrico Nuestra Sra. Del Carmen,
Garrapinillos, Spain
h Complejo Hospitalario San Luis, Palencia, Spain
a b s t r a c ta r t i c l e i n f o
Article history:
Received 15 August 2013
Revised 24 March 2014
Accepted 28 May 2014
Keywords:
NANDA-I nursing diagnoses
NIC interventions
NOC outcomes
Psychiatric diagnoses
Mental disorders
Aim: The aim of this study is to describe the most frequent
NANDA-I nursing diagnoses, NOC outcomes, and
NIC interventions used in nursing care plans in relation to
psychiatric diagnosis. Background: Although
numerous studies have described the most prevalent NANDA-I,

NIC and NOC labels in association with
medical diagnosis in different specialties, only few connect
these with psychiatric diagnoses. Methods: This
multicentric cross-sectional study was developed in Spain. Data
were collected retrospectively from the
electronic records of 690 psychiatric or psychogeriatric patients
in long and medium-term units and,
psychogeriatric day-care centres. Results: The most common
nursing diagnoses, interventions and outcomes
were identified for patients with schizophrenia, organic mental
disorders, mental retardation, affective
disorders, disorders of adult personality and behavior, mental
and behavioural disorders due to psychoactive
substance use and neurotic, stress-related and somatoform
disorders. Conclusion: Results suggest that
NANDA-I, NIC and NOC labels combined with psychiatric
diagnosis offer a complete description of the
patients' actual condition.
© 2014 Elsevier Inc. All rights reserved.
1. Background
Over the last decades, in the context of mental health care,
important
reforms have taken place to promote the deinstitutionalization
of
patients in many occidental countries (WHO & Wonca, 2008).
In this
line, in Spain numerous changes have been undertaken to adopt
a
community-based model of mental health care (Ministry of
Health,
Equality Social Services, 2012). The Mental Health Strategy of
the
Spanish National Health System 2009–2013 is the current

guidance
document that, based on the evaluation of the present situation,
outlines
the main lines of strategy and objectives for the improvement of
mental
health care (Ministry of Health, Equality Social Services, 2012).
This
document acknowledges the relevance of nurses' function and
promotes the incorporation of nurses who are certified as
psychiatric–
mental health clinical nurse specialist as part of
interdisciplinary teams
among all mental health care services. The mental health care
services
include a variety of different types of health care settings for
adult
patients: community mental health care centres, day
care/psychosocial
rehabilitation centres, community residential/supported living
services,
Applied Nursing Research 28 (2015) 92–98
⁎ Corresponding author at: Health Science Department, Public
University of Navarre.,
Avenida de Barañain s/n. 31008, Pamplona, Navarre, Spain.
Tel.: +34 948 14 06 11.
E-mail addresses: [email protected] (P. Escalada-Hernández),
[email protected] (P. Muñoz-Hermoso), [email protected]
(E. González–Fraile), [email protected] (B. Santos),
[email protected] (J.A. González-Vargas),
[email protected] (I. Feria-Raposo), [email protected]
(J.L. Girón-García), [email protected] (M. García-Manso).
1 The researchers who were part of the CUISAM Group were:

Uxua Lazkanotegui
Matxiarena, Itxaso Marro Larrañaga, Janire Martínez Berrueta,
Miren Arbelóa Álvarez,
Miriam García Sanabria, David Rodríguez Merchán, Cristina
Flores Del Redal López and
Marta Alameda Blanco from Clínica Psiquiátrica Padre Menni
(Pamplona, Spain);
Mertxe Olondriz Urrutia and Maite Dendarrieta Bardot from
Centro Hospitalario Benito
Menni (Elizondo, Spain); Almudena Bueno García, Elena
Muñoz Jiménez, Mª Esperanza
Pozo Cambeiro, Inmaculada Romero López, Juan Tomás
Jiménez Pereña, Laura Cebreros
Cuberos, Laura Marín Rubio, Marina Rubio Guerrrero, Rocío
Jiménez Sánchez, Sergio
Víctor Mata Reyes, Antonia Mª Ariza Nevado and Verónica
Aguilar Pérez from Complejo
Asistencial Hermanas Hospitalarias (Málaga, Spain); Mª
Carmen Vilchez Estévez,
Mónica Pastor Ramos and Alberto Carnero Treviño from Benito
Menni CASM (Sant Boi,
Spain); Nuria García Sola, Natividad Izaguerri Mochales, Elena
Martínez Araus, Eva Sanz
Báguena, Silvia Gabasa Galbez from Centro Neuropsiquiátrico
Nuestra Sra. Del Carmen
(Zaragoza, Spain); Emilio Negro González from Complejo
Hospitalario San Luis
(Palencia, Spain).
http://dx.doi.org/10.1016/j.apnr.2014.05.006
0897-1897/© 2014 Elsevier Inc. All rights reserved.
Contents lists available at ScienceDirect
Applied Nursing Research

journal homepage: www.elsevier.com/locate/apnr
http://crossmark.crossref.org/dialog/?doi=10.1016/j.apnr.2014.0
5.006&domain=pdf
mailto:[email protected]
http://www.sciencedirect.com/science/journal/08971897
acute psychiatric units, medium and long-term psychiatric units
and
psychogeriatric residential units (SIAP, 2009).
The nurses' role within the interdisciplinary teams can be
supported and enhanced with research on nursing care and
practice
in the different mental health care services of the Spanish
context. The
use of standardized languages to describe the elements of the
nursing
process provides a systematic approach toward patient care and
allows describing nursing practice in a precise way (Johnson,
Moorhead, Bulechek, Maas, & Swanson, 2011; Nanda
International,
2012; Thoroddsen, Ehnfors, & Ehrenberg, 2010). The nursing
diagnoses classification of the NANDA-International (NANDA-
I;

Nanda International, 2012), the Nursing Outcomes
Classification
(NOC; Moorhead, Johnson, Maas, & Swanson, 2013) and the
Nursing
Interventions Classification (NIC; Bulechek, Butcher,
Dochterman, &
Wagner, 2013) are three coded and standardized nomenclatures
that
refer to the nursing process elements of diagnoses,
interventions, and
outcomes. Each element in NANDA-I, NIC and NOC
taxonomies
consists of a label name, a definition and a unique numeric
code.
NANDA-I, NIC and NOC terminologies have widely been
researched
and applied (Anderson, Keenan, & Jones, 2009; Johnson et al.,
2011).
The three classifications together have the potential to represent
the domain of nursing in all settings (Johnson et al., 2011).
Thoroddsen et al. (2010) compared nursing diagnoses and
nursing
interventions in four selected nursing specialties, including
surgical,
medical, geriatric, and psychiatric areas. They concluded that
NANDA-I and NIC taxonomies illustrated the specific
knowledge of
each specialty and were very useful in describing basic human
needs
and nursing care in clinical practice. Nonetheless, they argued
that
further research should be developed to identify specific
nursing
diagnoses, nursing interventions and outcomes in different
special-

ties. Two studies identified nursing phenomena (Frauenfelder,
Müller-Staub, Needham, & Van Achterberg, 2011) and nursing
interventions (Frauenfelder, Müller-Staub, Needham, &
Achterberg,
2013) mentioned in journal articles on adult psychiatric
inpatient
nursing care and compared them with the NANDA-I and NIC
terminologies respectively. Both studies concluded that these
taxon-
omies described the majority, but not all, of concepts mentioned
in the
literature. The authors suggested that additional development of
the
taxonomies is needed to include all the relevant phenomena and
interventions for the nursing work in adult inpatient settings
(Frauen-
felder et al., 2011, 2013).
Numerous studies in different specialties have analyzed
NANDA-I,
NIC and NOC elements in association with medical diagnoses
or
diagnosis-related groups. It has been demonstrated that their
concurrent application offers complementary information about
a
patient's actual condition that can be employed to predict
patient
outcomes or use of resources (Güler, Eser, Khorshid, & Yücel,
2012;
van Beek, Goossen, & van der Kloot, 2005; Welton & Halloran,
2005).
In psychiatry and mental health care, only two studies
examining the
prevalence of nursing diagnoses according to different
psychiatric
diagnoses have been located. Ugalde Apalategui and Lluch

Canut
(2011) described the most prevalent NANDA-I labels for nine
diagnosis-related groups and Vílchez Esteve, Atienza
Rodríguez,
Delgado Almeda, González Jiménez, and Lorenzo Tojeiro
(2007) for
five psychiatric diagnoses. Moreover, two additional papers
examined
nursing diagnoses in patients with a specific psychiatric
diagnosis,
such as schizophrenia (Chung, Chiang, Chou, Chu, & Chang,
2010;
Lluch Canut et al., 2009).
Beyond prevalence analyses, several research projects have
examined the relationship between the number of nursing
diagnoses,
as a measure of nursing complexity, and patient outcomes. For
example, Moon (2011) found that the number of nursing
diagnoses
was significantly related to the changes in selected NOC scores
in ICU
patients and Sherb et al. (2013) obtained similar results in
patients
with pneumonia or heart failure. In acute cardiac care, Meyer,
Wang,
Li, Thomson, and O'Brien-Pallas (2009) demonstrated that the
number of nursing diagnoses increased the likelihood of
suffering
medical consequences (e.g., medical errors with consequences,
urinary tract or wound infections) and reduce the extent to
which
physical and mental health improved at discharge (measured by
difference scores between admission and discharge in the SF-12
Health Status Survey). To the author's knowledge, this aspect

has not
been explored in psychiatric patients.
Examining nursing practice by analyzing NANDA-I, NIC and
NOC
labels mentioned in nursing records in mental health nursing
practice
may contribute to develop knowledge within the specialty. The
aim of
this study is to describe the most frequent nursing diagnoses,
outcomes, and interventions used in nursing care plans for
psychiatric
and psychogeriatric patients in medium and long-term care
facilities
in relation to psychiatric diagnosis. The research questions
were:
(a) Which nursing diagnoses, outcomes and interventions are
used in
nursing care plans according to psychiatric diagnosis? (b) Is
there any
relationship between the variables number of nursing diagnoses,
psychiatric diagnosis, age or gender and the degree of severity
of
problems associated with mental illness?
2. Research methods
2.1. Data collection procedures and sample
This multicentric cross-sectional study was performed in 5
psychiatric clinics in different regions of Spain. These centres
belong
to the Congregation of Sisters Hospitallers of the Sacred Heart
of Jesus.
The electronic medical record software used in these centres
integrates NANDA-I, NIC and NOC taxonomies and nurses have

used
them routinely to develop healthcare plans for some years now.
Data were collected retrospectively from the nursing care plans
included in the electronic patient records. No sampling strategy
was
used as the whole study population was included in the study.
The
study population consisted of all those records of patients
fulfilling the
inclusion/exclusion criteria who were hospitalized between June
2010 and July 2011. Subjects eligible for inclusion were adult
(aged
over 18) psychiatric and psychogeriatric patients, who had a
nursing
care plan with NANDA-I, NIC and NOC labels and stayed at
any of the
healthcare facilities under study. These were long-term
psychiatric
units, medium-term psychiatric units, long-term psychogeriatric
units
and psychogeriatric day-care centres. Long-term units are
residential
services and patients may stay there indefinitely. Patients
usually stay
in medium-term units between 1 and 6 months. As exclusion
criteria,
due to ethical considerations, all patients in a terminal condition
were
not considered eligible. Records of patients who were
readmitted
after discharge during the data collection period were excluded.
This research project was approved by the Ethical and Scientific
Research Committee of Navarra. To ensure anonymity each
electronic

patient record was assigned an ID-number. Access to medical
electronic
records was granted by participating centres. In addition,
although not
necessary, written informed consent from all participants or
their legal
guardians was obtained to add ethical value to the study. In
order to
facilitate a systematic data collection, all members of the
research team
used a data collection form and received a training session.
2.2. Variables
The content of the data collection form consisted of 4 data sets
relating to socio-demographic details, medical information,
NANDA-I,
NIC and NOC codes and the Health of the Nation Outcome
Scale
(HoNOS), respectively. The socio-demographic details collected
were
age, gender, marital status, socio-economic status, education
and
employment situation. The medical information included
primary
psychiatric diagnosis according to ICD-10 classification
(secondary
diagnoses, if present, were not considered), clinical area
(psychiatry
or psychogeriatry) and type of healthcare setting (i.e. day-care
centre,
93P. Escalada-Hernández et al. / Applied Nursing Research 28
(2015) 92–98

medium or long-term unit). In relation to NANDA-I, NIC and
NOC
taxonomies, the codes of nursing diagnoses, outcomes and
interven-
tions documented in nursing care plans were recorded. In
addition,
clinical problems and social functioning of patients were
assessed by
HoNOS in its Spanish version (Uriarte et al., 1999). HoNOS is
an
instrument with 12 items designed to measure the whole range
of
physical, personal and social problems associated with mental
illness.
The score in each item ranges from 0 (i.e. without problems) to
4
(serious or very serious problems). Thus, the total HoNOS score
may
range from 0 to 48.
This scale has a broad clinical and a social coverage; it is used
as a
clinical outcome measure and is suitable for routine application
by
nurses (Pirkis et al., 2005; Wing et al., 1998). Different studies
of the
psychometric properties of the scale showed an adequate
internal
consistence with Cronbach's alpha ranging from 0.59 to 0.76,
indicating that HoNOS provides a clear overview of severity of
symptoms (Pirkis et al., 2005). Studies that analyzed the test–
retest
reliability of the scale have reported fair to moderate scores and
those
that examined its inter-rater reliability concluded that overall

agreement between raters was moderate to good for the HoNOS
total score (Pirkis et al., 2005).
2.3. Data analyses
Data were analyzed with MS Excel and STATA V.12.1 software
(StataCorp LP). To determine the most frequent NANDA-I, NIC
and
NOC labels in relation to psychiatric diagnosis, the sample was
divided
into groups according psychiatric diagnosis categories.
Descriptive
analyses were performed using absolute frequency distribution
and
percentage. For the second research question, additional
statistical
analyses were executed on the data from the total sample. The
Pearson correlation coefficient was calculated to explore the
relation-
ship between the number of nursing diagnoses and the total
score in
HoNOS. A multiple regression model was performed where total
HoNOS score was the independent variable and the dependent
variables were psychiatric diagnosis, number of nursing
diagnoses,
age and gender.
3. Results
Socio-demographic information of the study sample is presented
in Table 1. The final sample included the records of 690
patients. From
them, 434 (62.90%) were female and 256 (37.10%) were male.
The
average age was 67.9 ± 16.8 years (range 19–101). More than

50% of
subjects were married, around 70% had a socio-economic status
between low and medium, the majority (88%) were in pension
and
approximately 50% had primary school level education. The
number
of participants admitted in long-term psychiatric units was 219
(31.74%), 54 (7.83%) in medium-term psychiatric units, 351
(50.87%)
in long-term psychogeriatric units and, 66 (9.56%) in
psychogeriatric
day-care centres.
Psychiatric diagnoses were classified according to the main
categories of ICD-10, obtaining the following groups: group 1:
schizophrenia, schizotypal and delusional disorders (n = 362;
52.46%); group 2: organic mental disorders (n = 182; 26.38%);
group 3: mental retardation (n = 37; 5.36%); group 4: bipolar
affective disorders (n = 33; 4.78%); group 5: depressive and
other
affective disorders (n = 22; 3.19%); group 6: disorders of adult
personality and behaviour (n = 21; 3.04%); group 7: mental and
behavioural disorders due to psychoactive substance use (n =
17;
2.46%); group 8: neurotic, stress-related and somatoform
disorders
(n = 14; 2.03%); other disorders (n = 2; 0.30%).
Below, the main results will be presented in order of the
research questions.
3.1. (a) Which nursing diagnoses, outcomes and interventions
are used
in nursing care plans according to psychiatric diagnosis?
In all, 3681 nursing diagnoses, 4685 nursing outcomes and

13396
nursing interventions were recorded. The average number of
nursing
diagnoses per patient was 5.3. Similarly, the average numbers
of
nursing outcomes and nursing interventions per patient were 6.8
and
19.4 respectively.
Nursing diagnoses, outcomes and interventions were analyzed
within each psychiatric diagnosis group. The most frequent
NANDA-I,
NOC and NIC labels for each group are illustrated in Tables 2A
and 2B.
The most prevalent labels are mainly related to psychosocial
and
self-care deficit aspects. Certain patterns or profiles were
observed
within each psychiatric diagnosis group. In group 1
(schizophrenia,
schizotypal and delusional disorders), NANDA-I, NIC and NOC
terms
illustrated the usual needs faced by patients with schizophrenia
such
as disturbance of thought processes and social, communication,
anxiety and treatment compliance problems. Nursing diagnoses,
outcomes and interventions in relation to self-care deficit were
more predominant in groups 2 (organic mental disorders) and 3
(mental retardation). Within group 4 (bipolar affective
disorders),
NANDA-I, NIC and NOC labels are mainly related to self-care
deficits
and, symptom and side-effects management (i.e. disturbance of
thought processes and constipation) and treatment compliance.
NANDA-I, NIC and NOC labels in groups 5 (depressive and
other

affective disorders) and 8 (neurotic, stress-related and
somatoform
disorders) showed a special focus on anxiety problems. Groups
6
(disorders of adult personality and behaviour) and 7 (mental and
behavioural disorders due to psychoactive substance use) had a
majority of nursing diagnoses, outcomes and interventions
related to
social interaction and self-care needs. Moreover, some labels in
group
7 (mental and behavioural disorders due to psychoactive
substance
use) referred to side-effects such as constipation.
Table 1
Socio-demographic characteristics of the sample.
Data n %
Age groups
19–30 year 15 2.17
31–50 years 101 14.62
51–65 years 153 22.14
66–85 years 326 47.18
≥85 years 96 13.89
Gender
Women 432 62.70
Men 257 37.30
Marital status
Single 381 55.14
Married 99 14.33
Divorced/Separated 60 8.68
Widower 130 18.81
Unkown 21 3.04

Socio-economic status
Low 179 25.90
Low-medium 173 25.04
Medium 156 22.57
High-medium 63 9.12
High 16 2.32
Unkown 104 15.05
Education
Illiterate 74 10.71
Primary school level 332 48.05
Secondary school level 100 14.47
University level 51 7.38
Unknown 134 19.39
Employment situation
Employed 6 0.88
Unemployed 75 10.98
In pension 602 88.14
94 P. Escalada-Hernández et al. / Applied Nursing Research 28
(2015) 92–98
3.2. (b) Is there any relationship between the variables number
of
nursing diagnoses, psychiatric diagnosis, age or gender and the
degree of
severity of problems associated with mental illness?
Data from the total sample were used to examine potential
relationships between number of nursing diagnoses, psychiatric
diagnosis, age or gender and the degree of severity of problems
associated with mental illness (as reflected by HoNOS total

score). The
mean of the HoNOS score in the total sample was 13.24 ± 5.97.
The
result of the Pearson correlation test (r = 0.22) was statistically
significant (p b 0.05) and indicated a moderate positive linear
relationship between HoNOS total score and the number of
nursing
diagnoses. Several stepwise regression models were devised to
determine the explanatory factors for the HoNOS total score.
Initially,
number of nursing diagnoses, psychiatric diagnoses, age and
gender
were included as independent variables the HoNOS total score
as
dependent variable. The final multiple regression model (Table
3)
revealed that only gender and number of nursing diagnoses had
a
significant influence on the HoNOS total score. The gender
coefficient
(−1.35 ± 0.45) represents that adjusting for the nursing
diagnoses,
women would have had a HoNOS total score one point less than
men.
According to the coefficient of the number of nursing diagnoses
(0.44 ± 0.07), an increment of five diagnoses adjusting for
gender
represents a 2-point increment in the HoNOS total score.
4. Discussion
The findings of this study describe the most frequent NANDA-I,
NIC
and NOC labels for groups of patients with different psychiatric
diagnoses in medium and long-term units. Overall, some
common

aspects among all groups were found. NANDA-I, NIC and NOC
labels in
all groups reflected nursing care related to patients'
psychosocial
needs, self-care deficits and management of the therapeutic
regimen.
The domain of psychiatric nursing specialty, although not
exclusively,
focuses on these aspects (Frauenfelder et al., 2011; Sales Orts,
2005;
Ugalde Apalategui & Lluch Canut, 2011). Nursing care related
to
patients' psychosocial needs were described by nursing
diagnoses
such as disturbed thought processes, impaired social interaction,
impaired verbal communication, deficient diversional activity or
anxiety;
outcomes such as distorted thought self-control, social
interaction skills,
cognitive orientation, leisure participation or anxiety self-
control; and
interventions such as active listening, anxiety reduction,
socialization
enhancement, reality orientation, exercise promotion or coping
enhance-
ment. In relation to self-care needs, for instance, several
nursing
diagnoses of self-care deficit (i.e. bathing, dressing, and
feeding) and its
related outcomes and interventions can be observed.
Furthermore,
NANDA-I, NIC and NOC labels such as ineffective self health
management, medication management or medication
administration
illustrated how attention to the management of the therapeutic

Table 2A
Most frequent NNN labels by psychiatric diagnosis group.
Group 1: schizophrenia, schizotypal
and delusional disorders (n = 362)
Group 2: organic mental
disorders (n = 182)
Group 3: mental
retardation (n = 37)
Group 4: bipolar affective
disorders (n = 33)
NANDA n % NANDA n % NANDA n % NANDA n %
108 self-care deficit: bathing 207 57,18 109 self-care deficit:
dressing 122 67,03 108 self-care deficit: bathing 17 45,95 108
self-care deficit: bathing 16 48,48
130 disturbed thought
processes
174 48,07 108 self-care deficit: bathing 116 63,74 109 self-care
deficit: dressing 15 40,54 11 constipation 13 39,39
52 impaired social interaction 139 38,40 102 self-care deficit:
feeding 89 48,90 102 self-care deficit: feeding 8 21,62 130
disturbed thought
processes
12 36,36
51 impaired verbal
communication
108 29,83 131 impaired memory 71 39,01 11 constipation 7

18,92 78 ineffective self health
management
12 36,36
78 ineffective self health
management
108 29,83 51 impaired verbal
communication
59 32,42 97 deficient diversional
activity
6 16,22 97 deficient diversional
activity
11 33,33
NOC n % NOC n % NOC n % NOC n %
305 self-care: hygiene 168 46,41 300 self-care: activities of
daily
living (ADL)
150 82,42 300 self-care: activities of
daily living (ADL)
19 51,35 1612 weight control 9 27,27
1403 distorted thought
self-control
153 42,27 305 self-care: hygiene 105 57,69 305 self-care:
hygiene 15 40,54 300 self-care: activities of
daily living (ADL)

8 24,24
300 self-care: activities of
daily living (ADL)
133 36,74 1101 tissue integrity:
skin and mucous membranes
80 43,96 302 self-care: dressing 10 27,03 305 self-care: hygiene
8 24,24
901 cognitive orientation 126 34,81 302 self-care: dressing 77
42,31 1604 leisure participation 8 21,62 1403 distorted thought
self-control
8 24,24
1502 social interaction skills 126 34,81 902 cognitive
orientation 57 31,32 501 bowel elimination 7 18,92 1608
symptom control 8 24,24
NIC n % NIC n % NIC n % NIC n %
1801 self-care assistance:
bathing/hygiene
226 62,43 6480 environmental
management
156 85,71 5606 teaching: individual 24 64,86 200 exercise
promotion 23 69,70
5606 teaching: Individual 212 58,56 1801 self-care assistance:
bathing/hygiene
137 75,27 1801 self-care assistance:
bathing/hygiene

19 51,35 5820 anxiety reduction 20 60,61
5820 anxiety reduction 194 53,59 5606 teaching: Individual 128
70,33 5820 anxiety reduction 16 43,24 4820 reality orientation
17 51,52
4820 reality orientation 175 48,34 6490 fall prevention 120
65,93 200 exercise promotion 15 40,54 2300 medication
administration
16 48,48
5100 socialization
enhancement
dressing/grooming
119 65,38 1800 self-care assistance 13 35,14 5606 teaching:
individual 15 45,45
2380 medication
management
management: safety
management
bathing/hygiene
14 42,42
4920 active listening 147 40,61 1800 self-care assistance 107

58,79 1802 self-care assistance:
dressing/grooming
12 32,43 4920 active listening 14 42,42
4480 self-responsibility
facilitation
146 40,33 6460 dementia management 102 56,04 1670 hair care
12 32,43 2380 medication
management
13 39,39
5230 coping enhancement 145 40,06 4820 reality orientation 97
53,30 1680 nail care 11 29,73 4480 self-responsibility
facilitation
13 39,39
4362 behavior modification:
social skills
feeding
92 50,55 1660 foot care 11 29,73 5100 socialization
enhancement
13 39,39
(2015) 92–98

regimen also appeared in the nursing care plans. This supports
the
conclusions of Thoroddsen et al. (2010), who demonstrated that
standardized nursing languages have the potential of
representing
specific knowledge within nursing specialties, including mental
health nursing.
Within each psychiatric diagnosis group specific patterns and
features can be observed, demonstrating that psychiatric
diagnosis
and NANDA-I, NIC and NOC labels were related. Findings in
group 1
(i.e. patients with schizophrenia) are consistent with the
literature.
Three of the most prevalent nursing diagnoses in this group:
disturbed
thought processes, ineffective self health management and self-
care
deficit: bathing were also found very frequent in other studies
on
patients with schizophrenia and schizotypal and delusional
disorders
(Chung et al., 2010; Lluch Canut et al., 2009; Ugalde
Apalategui &
Lluch Canut, 2011; Vílchez Esteve et al., 2007) For the rest of
the
psychiatric diagnosis groups, comparisons between this study
and the
other two existing studies are difficult as they classified
psychiatric
diagnoses in a different way, using diagnosis-related groups
(Ugalde
Apalategui & Lluch Canut, 2011) or other diagnostic categories
such as

mania, depression, dual disorders or adaptative disorders
(Vílchez
Esteve et al., 2007). Clinical manifestations and diagnostic
criteria
differ among classifications, and therefore, patients'
characteristics
and needs in each group will be different in some degree.
The statistical analyses performed showed that HoNOS total
score
was related with the variable number of nursing diagnoses and
not
with the variable psychiatric diagnosis. Based on these results,
it could
be argued that the degree of severity of patients' problems has
an
impact on nursing care requirements. This relationship between
patients' level of physical and mental health and number of
nursing
diagnoses has been demonstrated in previous research (Meyer et
al.,
2009). This result supports the use of number of nursing
diagnoses as
a measure of nursing complexity that could be used as
predictors of
patient outcomes (Meyer et al., 2009; Moon, 2011; Sherb et al.,
2013).
Nursing diagnoses may provide relevant data that could be
applied to
inform predictions or management decisions about nurse
staffing or
Table 2B
Most frequent NNN labels by psychiatric diagnosis group.
Group 5: depressive and other

affective disorders (n = 22)
Group 6: disorders of adult
personality and behavior (n = 21)
Group 7: mental and behavioural
disorders due to psychoactive
substance use (n = 17)
Group 8: neurotic, stress-related and
somatoform disorders (n = 14)
NANDA n % NANDA n % NANDA n % NANDA n %
108 self-care deficit:
bathing
12 54,55 108 self-care deficit: bathing 11 52,38 108 self-care
deficit: bathing 13 76,47 52 impaired social
interaction
7 50,00
130 disturbed thought
processes
9 40,91 97 deficient diversional activity 7 33,33 51 impaired
verbal
communication
8 47,06 108 self-care deficit: bathing 5 35,71
146 anxiety 8 36,36 52 impaired social interaction 6 28,57 52
impaired social interaction 7 41,18 146 anxiety 5 35,71
109 self-care deficit:
dressing

7 31,82 109 self-care deficit: dressing 6 28,57 11 constipation 5
29,41 109 self-care deficit:
dressing
4 28,57
16 impaired urinary
elimination
7 31,82 78 ineffective self health
management
5 23,81 109 self-care deficit: dressing 4 23,53 130 disturbed
thought
processes
4 28,57
NOC n % NOC n % NOC n % NOC n %
305 self-care: hygiene 12 54,55 1604 leisure participation 8
38,10 300 self-care: activities of
daily living (ADL)
11 64,71 1502 social interaction skills 9 64,29
300 self-care: activities of
daily living (ADL)
8 36,36 1209 motivation 6 28,57 305 self-care: hygiene 10
58,82 305 self-care: hygiene 5 35,71
1403 distorted thought
self-control
8 36,36 305 self-care: hygiene 5 23,81 1604 leisure
participation 6 35,29 1403 distorted thought

self-control
5 35,71
1502 social interaction skills 7 31,82 1101 tissue integrity: skin
and
mucous membranes
5 23,81 501 bowel elimination 5 29,41 1503 social involvement
5 35,71
4 sleep 7 31,82 300 self-care: activities of daily
living (ADL)
4 19,05 901 cognitive orientation 5 29,41 1402 anxiety self-
control 5 35,71
NIC n % NIC n % NIC n % NIC n %
5820 anxiety reduction 20 90,91 200 exercise promotion 15
71,43 1801 self-care assistance:
bathing/hygiene
15 88,24 5820 anxiety reduction 12 85,71
1801 self-care assistance:
bathing/hygiene
16 72,73 5230 coping enhancement 12 57,14 200 exercise
promotion 15 88,24 4362 behavior modification:
social skills
12 85,71
5606 teaching: individual 12 54,55 4310 activity therapy 11
52,38 5820 anxiety reduction 10 58,82 5100 socialization
enhancement

10 71,43
5230 coping
enhancement
12 54,55 5100 socialization enhancement 11 52,38 6486
environmental
management: safety
9 52,94 5230 coping enhancement 10 71,43
4820 reality orientation 11 50,00 5820 anxiety reduction 11
52,38 5100 socialization
enhancement
9 52,94 200 exercise promotion 9 64,29
2300 medication
administration
11 50,00 6490 fall prevention 11 52,38 4820 reality orientation
bathing/hygiene
7 50,00
4920 active listening 10 45,45 6486 environmental management:
safety
10 47,62 6490 fall prevention 8 47,06 4310 activity therapy 6
42,86
2380 medication
management

10 45,45 4920 active listening 10 47,62 5606 teaching:
Individual 7 41,18 4640 anger control
assistance
6 42,86
6486 environmental
management: Safety
10 45,45 2380 medication management 9 42,86 2300 medication
administration
7 41,18 4920 active listening 6 42,86
1850 sleep enhancement 9 40,91 4420 patient contracting 8
38,10 1800 self-care assistance 6 35,29 4820 reality orientation
6 42,86
Table 3
Final multiple regression model.
Dependent variable: HoNOS score Significance
R2 = 0.566 0.000
Model
(independent variables)
Stand coefficient
(beta)
Significance CI 95%
Low High
Gender −1.353 0.003 −2.247 −0.459

Number of diagnoses 0.439 0.000 0.292 0.586
(2015) 92–98
resource utilisation (Hoi, Ismail, Ong, & Kang, 2010; Meyer et
al.,
2009; Morales-Asencio et al., 2009).
The results of this study offer a broad picture of the nursing
care to
psychiatric and psychogeriatric patients in medium and long-
term
care settings, as they included the three main aspects of the
nursing
process (i.e. nursing diagnoses, interventions and outcomes). In
addition, information about the specific nursing care needs in
relation
to a determined psychiatric diagnosis has been obtained. Thus,
the
present study contributes, to some extent, to complete the
existing
evidence. As explained above, only a small number of studies
examining nursing diagnoses in association to specific
psychiatric
diagnoses were located and research on NANDA-I, NIC or NOC
taxonomies in psychiatry and mental health has been mainly
developed in acute care or community settings and only
included
either nursing diagnoses or nursing interventions (Escalada
Hernández,
Muñoz Hermoso, & Marro Larrañaga, 2013). Additional
research is
needed to complete and validate the findings of this study. The

evidence obtained from this kind of studies will contribute to
reinforce the mental health nurses' role within multidisciplinary
teams as can be applied for evidence-based practice, planning
continuing education programs, the improvement of the quality
of care, the development of standardized care plans and to
provide evidence of the value of mental health nurses' work to
stakeholders (Jones, Lunney, Keenan, & Moorhead, 2010;
Nanda
International, 2012).
The present study has some potential limitations. Data were
obtained retrospectively from electronic patient records and not
from
direct observation of nurses' work. Therefore, the study results
illustrate documented care and not delivered care. The use of
standardized language has been shown to improve the amount
and
quality of data documented (Saranto et al., 2013). However,
other
studies have found that nurses tend to communicate and register
less
activities than those they actually perform (De Marinis et al.,
2010;
Jefferies, Johnson, & Griffiths, 2010). On the other hand, as the
sample
was divided into groups according to psychiatric diagnosis, the
total
number of patients in the groups related to less prevalent
pathologies
is very low. Therefore, findings from these groups should be
examined
with caution and future studies focusing on those psychiatric
disorders are needed to complete these results.
5. Conclusions

The results of this study showed that the most common nursing
diagnoses, interventions and outcomes documented in nursing
care
plans for psychiatric and psychogeriatric patients admitted in
medium and long-term care units and psychogeriatric day-care
centres are mainly related to psychosocial, self-care deficits and
management of the therapeutic regiment. The most frequent
NANDA-I, NIC and NOC labels for each psychiatric diagnosis
have
been identified and specific patterns and differences between
groups
can be observed. Furthermore, the degree of severity of
problems
associated with mental illness, measured by HoNOS, has been
shown
to be related to the number of nursing diagnoses recorded in the
care
plan and not to the patient's psychiatric diagnosis. From the
findings
presented here, it could be concluded that NANDA-I, NIC and
NOC
labels combined with psychiatric diagnoses offer a
comprehensive
description of psychiatric and psychogeriatric patients' actual
condi-
tion, their problems and needs.
Acknowledgments
We are grateful to the Fundación Mª Josefa Recio and the
Clínica
Psiquiátrica Padre Menni who funded this project and supported
its development.
Borja Santos was supported by the Department of Education,
Universities and Research of the Government of the Basque

Country
(DEUI) through the Training and Development Programs for
Research
Staff (BFI-2011-212).
The authors would like to thank Sr Patricia Grady ODN for the
valuable review of the manuscript for English usage.
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©2015 Elsevier

MSN5250: Statistics
for Advanced Nursing Practice
Team:____________
Critique Worksheet for Group Project Part A
Elements of Critique Discussion
State the practice problem/issue that is the focus of the
study.
How does this practice problem/issue affect your
nursing practice?
In your own words, state the purpose of the study.
Is the research question clearly stated?
What is the research question?
Does it match the purpose of the study?
Is the research hypothesis clearly stated?

What is the research hypothesis?
Does the hypothesis reflect the purpose of the study?
Formulate a null hypothesis for this study.
Who is identified as the target population?
How were the subjects chosen (e.g., randomly,
conveniently)?
Who is included (e.g., males, females, children,
adults)?
Who is excluded (e.g., elderly, pregnant women,
minorities)?
How large is the sample?
How was sample size determined?
List the research variables.
How are the variables described?

What instruments or tools were used to collect data?
Are the instruments sufficient for measuring the study
variables? How is this assessed?
Are the instruments valid and reliable?
Are the instruments adequately described for you to
understand what the score means?
State the data collection procedures.
How often was data collected and for how long?
Were data analysis procedures clearly described?
Were data logically organized/presented in tables,
graphs and/or charts? Describe.
What statistical tests were used to analyze data?
What assumptions in the data must be met for the type
of statistical tests used? Were these assumptions met?

What were the levels of measurement for each variable
in the study?
Were statistical tests suitable to the types of data
collected/levels of measurement?
What was the alpha for each variable?
Describe how statistical significance was demonstrated
(or not) for each variable.
Discuss study results. What were the findings?
Is the research question/hypothesis answered?
Were study limitations described?
Can generalizations be made?
Were there any unexpected findings?

Discuss study recommendations.
Is there an identified need for further research?
Do study findings have clinical significance?
Who will benefit from results of the study?
Discuss implications of the study for nursing practice.
What changes could you make in your practice based
on the results of this study?

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