Parellada-Vendrell et al.1 recently published a clinical case in the journal ENFERMERÍA INTENSIVA about treatment in the field of structural interventional cardiology. We congratulate the authors on the optimisation of the patient’s care and their outcome. However, there are some comments related to the methodology used in this study which, if not clarified, could lead to errors in clinical practice and the taking on of functions not appropriate to our profession.2
Firstly, we perceive some confusion in the discussion section with the context of the case, as the authors mention certain nursing interventions that would be key to the patient arriving in the best possible clinical conditions for mitral valve implantation. The case description explains that the patient was admitted to the acute cardiac care unit after implantation and after referral from the outpatient clinic due to their symptoms. In fact, the assessment and the corresponding care plan were made post-intervention, as they cover the complications that developed after implantation; this is confusing for the reader.
Secondly, a care plan is created that does not correspond at all to the competencies acquired in our day-to-day work, and does not provide a solution to the problems detected.2 The nursing diagnoses (ND) identified by the authors1 are erroneous, because we cannot manage them autonomously; a medical prescription is needed for a series of measures to be adopted and which the nurse is obliged to carry out. An “Ineffective breathing pattern” (00032) in which oxygen and certain drugs will be needed or the “Decreased activity tolerance” (00298) caused by the condition for which the patient was admitted are not autonomous interventions. Incidentally, the “Intolerance” (00092) that the authors mention in the case was changed to ND (00298). Furthermore, risk diagnoses cannot be related to medical problems or treatments, since, if we do not eliminate the source of risk, the problem will continue to exist, and again it is the doctor who has the autonomy to do so. Specifically, the “Risk of deterioration of skin integrity” (00047) would be well formulated if it were not related to physical immobility; remember, the patient was on complete bedrest as ordered by the doctor and unable to undertake any activity due to their incapacitating condition.
Thirdly, “Disturbed sleep pattern” (00198) cannot be considered an ND when pharmacological support is needed to treat it, since nurses do not prescribe this type of treatment. We would be taking on roles, therefore, that are not appropriate to our field of activity. All the clinical nursing judgements identified by the authors1 are problems of collaboration.
Finally, we believe it appropriate to consider hypothyroidism and hypertension collaborative problems, diseases that the patient suffered prior to this acute condition, and which are completely ignored in this care plan, although they are very relevant for a good outcome.
To conclude, according to NANDA I,3 an ND involves making a clinical judgement about a human response (there is certainly no assessment of the patient's state of mind in the acute process) and confirms that nurses in practice cannot use all the available NDs if they are outside the standards or competencies of the country in which they exercise their profession.
It does little to help us advance in the development of models, theoretical frameworks, and methodology if we do not assimilate the basics, and intrude into the roles of other professions.
