https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/11/25/methode-adii
Goal is to assist nurses in data synthesis, analysis, and subsequent interprofessional communication
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ADII stands for abnormal data (AD), issues (I), and interventions (I). The ADII method, a distillation of the nursing process, was created to assist students and nurses in quickly analyzing abnormal client data and, subsequently, in formulating concise SBAR statements for use when collaborating with physicians or prescribers.
Takeaway messages
- Assessment data synthesis, analysis, and subsequent interprofessional communication are challenging aspects of practice for novice nurses and students.
- The culture that surrounds the strict delineation between medical and nursing diagnoses contributes to the challenges that some nurses experience in their assessment data analysis and subsequent interprofessional communication.
- It is believed that the ADII method will assist nurses in data synthesis, analysis, and subsequent interprofessional communication, inasmuch as it allows for the consideration of medical diagnoses alongside nursing diagnoses, and dovetails seamlessly with the SBAR communication tool.
I have often noticed, during lab simulations or within clinical practicums, student nurses struggling to construct concise reports that they intend to share with physicians. It seems a challenge for them to effectively funnel their abnormal data and related analysis into an SBAR report.
Poor interprofessional communication has been cited as a major cause for the abandonment of the nursing profession by recent graduates (Raurell-Torredà et al., 2021). Effective data analysis is foundational in the formulation of reports communicated within and between professions (Lanz & Wood, 2018). I formulated the ADII (“ah-dee”) method to help students better align abnormal data, and their analysis of it, with their subsequent interprofessional communication.
ADII stands for abnormal data (AD), issues (I), and interventions (I). In this article, I discuss the relationship between the SBAR communication tool and data analysis, and how the ADII method might assist students in synthesizing their abnormal findings into a streamlined report.
SBAR is only as effective as the data analysis that precedes it
SBAR, which stands for situation, background, assessment, and recommendation, is a well-established handover and communication tool used by nurses (Park, 2020). The use of SBAR in simulated client scenarios improves the communication, teamwork, and interventions of the student nurse (Raurell-Torredà et al., 2021).
That being said, the efficacy of SBAR is limited to the nurse’s ability to recognize the important features of a clinical situation (Lanz & Wood, 2018), and it is intuitive that to recognize the important features of any situation, one must be able to organize the relevant data into meaningful clusters.
For example, in the recommendation section of SBAR, the nurse needs to be clear on what they need from the professional to whom they are reporting (Park, 2020). It is doubtful that the nurse will know what they need if they have not analyzed the data effectively.
Assessment and clinical reasoning are fundamental to the process of effective reporting, inasmuch as identifying the relevant data of an assessment is a necessary prerequisite for the development of an effective report (Lanz & Wood, 2018).
An essential element of communication in nursing involves summarizing and presenting assessment data, and relating assessment data to specific client issues (Lanz & Wood, 2018). These processes of data analysis, issue identification, and subsequent communication are challenging for many students (Lanz & Wood, 2018) and some nurses too (Cachón-Pérez et al., 2021).
In the section that follows, I provide an argument to support the notion that some of these challenges are linked to the manner in which we teach and apply aspects of the nursing process.
A call for innovation in the teaching and application of the nursing process
The difficulties that some students and nurses have in working with the nursing process have a direct impact on the processes of data analysis, issue identification, and subsequent communication (Cachón-Pérez et al., 2021; Korkut et al., 2021). The findings of Cachón-Pérez (2021) and Korkut (2021) seem to suggest that, in some contexts, there may be room for new and innovative approaches to the teaching and implementation of the nursing process.
In their integrated review, Tan et al. (2017) conclude that organizational and cultural changes are needed to overcome the interprofessional communication challenges that exist between nurses and physicians. I believe that these needed cultural changes include a shift in perspective around the strict delineation between medical and nursing diagnoses.
As I will discuss below, I believe that such a shift could have a positive impact on the efficacy of the analysis of data within the nursing process, and the subsequent interprofessional communication between nurses and physicians.
The limitations of nursing diagnoses
Students working with the nursing process have expressed challenges in linking data to nursing diagnoses and interventions (Korkut et al., 2021). Nurses working in an emergency department in Spain expressed the concern that not being well versed in the Nanda International terminology made the application of nursing diagnoses a cumbersome and pedantic process (Cachón-Pérez et al., 2021, p. 5).
When nursing diagnoses were applied to their work in the emergency department, these nurses found that doing so was of little value, as they “did not find a relationship between the actual work of an emergency department and the theorization of nursing diagnoses,” which they found too general to apply to their specific situations (Cachón-Pérez et al., 2021, p. 5).
Allowing for the language of medical diagnosis within the nursing process
The assignment of medical diagnoses does not fall within the scope of nursing practice, but the determination of nursing diagnoses is central to the nursing process. Use of the ADII method is not meant to challenge these two axioms of nursing practice. That said, Gleason et al. (2017) maintain that the “antiquated view” (p. 1) that medical diagnosis is solely a physician responsibility is in need of adjustment, in that nurses should have some engagement in the process, and that increasing the role of nurses in this regard will help to reduce diagnostic errors.
Gleason et al. (2017, p. 4) write, “making [a] diagnostic triage function explicit in nursing roles could markedly improve total-team diagnostic performance through earlier recognition of clinical red flags for dangerous conditions such as sepsis, pulmonary embolus, myocardial infarction, and stroke, especially for hospitalized patients.”
Nursing schools should ensure that their curriculum includes content that is specific to the diagnostic process (Gleason et al., 2017). It has been my clinical experience that if a nurse uses a sanctioned screening tool to detect a medical condition, such as sepsis, they will often communicate their concern using the diagnostic terminology of medicine, not the diagnostic statements commonly associated with the nursing process, such as those attributed to NANDA-I.
The ADII method: a case study
The ADII method, a distillation of the nursing process, was created to assist students and nurses in quickly analyzing abnormal client data and, subsequently, in formulating concise SBAR statements for use when collaborating with physicians or prescribers.
The ADII acronym stands for abnormal data (AD), issues (I), and interventions (I). The abnormal data of the ADII method is gathered through the assessment aspect of the nursing process. The issues aspect of ADII parallels the diagnosis aspect of the nursing process. Finally, the interventions aspect of ADII may be associated with the planning and implementation aspects of the nursing process.
The case study that follows illustrates the ADII method in action.
Abnormal data (AD)
The client underwent an appendectomy yesterday. Discharge is imminent, and no abnormal findings have been noted in the chart up to this point. The client’s vital signs have been within the range of a healthy adult, and there are no secondary medical diagnoses attached to their profile.
This morning, following a physical assessment of the client, the nurse identifies what appears to be new abnormal data. The nurse clusters the data into groupings that reflect anticipated issues or diagnoses (see case study summary below).
Issue (I)
The ADII method allows the nurse to consider, not assign, actual or potential medical diagnoses alongside nursing diagnoses, as doing so may increase their own understanding of the meaning of the data and optimizes the universality of any subsequent communication with the physician. The consideration of both medical and nursing diagnoses might strengthen the interprofessional collaboration between nurses and physicians, inasmuch as the language of nursing diagnoses has been viewed as inadequate for communication in some contexts (Cachón-Pérez et al., 2021).
In this case, the nurse has clustered the client data according to the identified nursing diagnoses (see case study summary below). In addition, to assist the nurse in determining the anticipated prescriber recommendations associated with the SBAR report, the nurse notes some of the potential medical diagnoses that could be associated with the abnormal data and nursing diagnoses.
Intervention (I)
The primary objective of the nurse at this point is to collaborate with the physician to obtain orders to facilitate the assignment of relevant diagnostic testing and treatment for the client. As such, the intervention section of the ADII method has been limited to potential orders that the nurse anticipates receiving from the prescriber (see case study summary below).
Case study summary
| Abnormal data (AD) |
Issues (I) |
Interventions (I) |
- BP 155/92; 115 BPM; RR 32; 97% SpO2 on room air; T37.2°C
- Shallow respiration depth; pain across chest with inspiration; decreased air entry to bases bilaterally
|
Nursing diagnoses:
- Ineffective breathing pattern
- Risk for decreased cardiac output
Potential medical diagnoses:
- Pneumonia
- Pulmonary embolism (PE)
- Myocardial infarction (MI)
|
Ineffective breathing pattern
- Pneumonia
- Chest X-ray
- Sputum sample
- ABX
- Analgesics
- Pulmonary embolism
- Spiral CT
- V/Q scan
- Anticoagulation
Risk for decreased cardiac output
|
- Pain, redness, and swelling in the left calf
|
Nursing diagnoses:
- Impaired tissue perfusion
Potential medical diagnoses:
- Deep venous thrombosis (DVT)
|
Impaired tissue perfusion
- Deep venous thrombosis
- D-dimer levels
- Doppler ultrasound
- Anticoagulation
|
ADII and SBAR formulation
The data analyzed through the ADII method dovetail seamlessly into an SBAR report (see Figure 1).
Situation, which includes nurse, location, and client identification (Park, 2020), is a logical way to initiate the conversation with the prescriber.
Background includes relevant medical and surgical history (Park, 2020).
Assessment includes the client’s current condition and what the nurse thinks the overall problems are (Park, 2020). The assessment content of SBAR lines up with the abnormal data and issues identified in the ADII method.
The recommendations section of SBAR includes what the nurse thinks is needed from the prescriber (Park, 2020), and this lines up with the interventions identified in the ADII method.
Figure 1
ADII and SBAR synthesis
Implications for further research
Further research around the ADII method could focus on the following areas:
- Interprofessional communication challenges related to the culture surrounding the strict delineation between medical and nursing diagnoses.
- The extent to which nurses cluster data according to perceived medical diagnoses rather than nursing diagnoses.
- The extent to which the ADII method facilitates effective data synthesis, analysis, and subsequent interprofessional communication.
- The extent to which the ADII method improves patient outcomes and the retention of nursing graduates.
I would like to acknowledge the mentorship of Dr. Lorraine Holtslander, instructor, Athabasca University; professor emeritus, University of Saskatchewan.
References
Cachón-Pérez, J.M., Gonzalez-Villanueva, P., Rodriguez-Garcia, M., Oliva-Fernandez, O., Garcia-Garcia, E., & Fernandez-Gonzalo, J.C. (2021). Use and significance of nursing diagnosis in hospital emergencies: a phenomenological approach. International Journal of Environmental Research and Public Health, 18(18). https://doi-org.ezproxy.vcc.ca/10.3390/ijerph18189786
Gleason, K.T., Davidson, P.M., Tanner, E.K., Baptiste, D., Rushton, C., Day, J., . . . & Newman-Toker, D.E. (2017). Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action. Diagnosis (Berlin, Germany), 4(4), 201–210. https://doi-org.ezproxy.vcc.ca/10.1515/dx-2017-0015
Korkut, S., Sahin, S., Ulker, T., & Cidem, A. (2021). Nursing students’ views of the nursing process and its challenges, and their solutions: a qualitative study. International Journal of Caring Sciences, 14(2), 811–824.
Lanz, A.S., & Wood, F.G. (2018). Communicating patient status: comparison of teaching strategies in prelicensure nursing education. Nurse Educator, 43(3), 162–165. https://doi-org.ezproxy.vcc.ca/10.1097/NNE.0000000000000440
Park, L.J. (2020). Using the SBAR handover tool. British Journal of Nursing, 29(14), 812–813. https://doi-org.ezproxy.vcc.ca/10.12968/bjon.2020.29.14.812
Raurell-Torredà, M., Rascón-Hernán, C., Malagón-Aguilera, C., Bonmatí-Tomás, A., Bosch-Farré, C., Gelabert-Vilella, S., & Romero-Collado, A. (2021). Effectiveness of a training intervention to improve communication between/awareness of team roles: a randomized clinical trial. Journal of Professional Nursing, 37(2), 479–487. https://doi.org/10.1016/j.profnurs.2020.11.003
Tan, T., Zhou, H., & Kelly, M. (2017). Nurse–physician communication — an integrated review. Journal of Clinical Nursing, 26(23–24), 3974–3989. https://doi-org.ezproxy.vcc.ca/10.1111/jocn.13832
Jason Cohen, RN, MN, is a nursing instructor at Vancouver Community College.
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