Relationship Between Nursing Diagnoses, Mortality and Length of Stay in the ICU: A Retrospective Cohort Study

Abstract

ABSTRACT Background Nursing process is a systematic, problem‐solving framework structuring clinical reasoning and patient‐centred care; within it, Nursing Diagnoses (ND) link clinical assessment to planning and implementing individualised interventions. However, evidence demonstrating ND ability to predict clinical outcomes using severity indices remains lacking. Aims The primary aim of this study was to describe the relationship between the number of ND on admission to an Intensive Care Unit (ICU) with mortality and ICU length of stay (ICU‐LOS). Secondarily, we aimed to assess their association with Charlson comorbidity index (CCI), Simplified Acute Physiology Score III (SAPS‐3) score and Nursing activities score (NAS). Study Design Retrospective cohort (22 April 2021–22 April 2022) study using data from medical records of patients aged ≥ 15 years admitted to an adult ICU of a Brazilian University Hospital. ND were based on the NANDA‐International taxonomy. According to the distributions of the variables, statistical tests were used to verify the relationship between the frequency of ND and the variables of interest. Results The sample ( n = 904; 54.4% male) had a mean age of 62.3 years (range: 15–101) and an average ICU‐LOS of 6.2 days (range: 1–79). There was an average of 5.2 ND per admission. No statistically significant relationship was observed between the number of ND and ICU‐LOS, CCI or SAPS‐3. However, logistic regression showed that each additional ND increased the odds of death by 13.6% (OR = 1.136; 95% CI: 1.035–1.248). Additionally, linear regression indicated a 0.65 percentage points NAS increase per additional ND (approximately 9 additional minutes of nursing care per day). Conclusion The number of ND at ICU admission is an independent predictor of mortality and nursing workload. Relevance to Clinical Practice These results support the clinical utility of ND, reinforcing their importance for standardising nursing data in practice and research.