The decision-making in clinical nursing, regarding diagnoses, interventions and outcomes, can be assessed using standardized language systems such as NANDA International, the Nursing Interventions Classification and the Nursing Outcome Classification; these taxonomies are the most commonly used by nurses in informatized clinical records. The purpose of this review is to synthesize the evidence on the effectiveness of the nursing process with standardized terminology using the NANDA International, the Nursing Interventions Classification and the Nursing Outcome Classification in care practice to assess the association between the presence of the related/risk factors and the clinical decision-making about nursing diagnosis, assessing the effectiveness of nursing interventions and health outcomes, and increasing people’s satisfaction. A systematic review was carried out in Medline and PreMedline (OvidSP), Embase (Embase-Elsevier), The Cochrane Library (Wiley), CINAHL (EbscoHOST), SCI-EXPANDED, SSCI and Scielo (WOS), LILACS (Health Virtual Library) and SCOPUS (SCOPUS-Elsevier) and included randomized clinical trials as well as quasi-experimental, cohort and case-control studies. Selection and critical appraisal were conducted by two independent reviewers. The certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation Methodology. A total of 17 studies were included with variability in the level and certainty of evidence. According to the outcomes, 6 studies assessed diagnostic decision-making and 11 assessed improvements in individual health outcomes. No studies assessed improvements in intervention effectiveness or population satisfaction. There is a need to increase studies with rigorous methodologies that address clinical decision-making about nursing diagnoses using NANDA International and individuals’ health outcomes using the Nursing Interventions Classification and the Nursing Outcome Classification as well as implementing studies that assess the use of these terminologies for improvements in the effectiveness of nurses’ interventions and population satisfaction with the nursing process.

Escape room games are educational gamification technologies that consist of introducing a team of players into a physical or digital space in search of clues to answer puzzles, riddles or enigmas and solve a mystery or problem. This study aims to determine the effectiveness of escape room games on the training of nursing students in an international context. A systematic review was carried out in MEDLINE, WOS, SCOPUS, CINAHL and LILACS databases using the MeSH terms “Education, Nursing” and “Educational Technology”, and the free term “Escape room”, combined with Boolean operators AND/OR. Intervention studies in Spanish, English and Portuguese were included, without limitation for the year of publication. Selection and critical appraisal were conducted by two independent reviewers. A total of n = 13 interventional studies were included (n = 2 Randomized Clinical Trials and n = 11 quasi-experimental design). Escape rooms are a recent and growing educational methodology, increasingly used in academia and in the training of nurses and nursing students. However, it is necessary to expand their use and the quality of the studies in a greater number of contexts. Furthermore, it is necessary to homogenize and standardize validated instruments to evaluate the effectiveness of escape rooms in the nursing education area.

The nursing process in clinical practice can be assessed using standardized language systems. The purpose is to find evidence on the effectiveness of the nursing process with standardized terminology using NANDA International, Nursing Interventions Classification, and Nursing Outcome Classification improving diag-nostic accuracy, nursing interventions, health outcomes, and people’s satisfaction. A systematic review was carried out in Medline and PreMedline, Embase, The Cochrane Library, CINAHL, SCI-EXPANDED, SSCI and Scielo and LILACS including randomized clinical trials, quasi-experimental, cohort and case-control studies. Selection and critical appraisal were conducted by two independent reviewers. The certainty of the evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation Methodology. 17 studies were included with variability in the level and certainty of evidence. According to outcomes, 6 evaluated improvements in diagnostic accuracy and 11 evaluated improvements in individual health outcomes. No studies evaluated improvements in intervention efficacy or population satisfaction. There is a need to increase studies with rigorous methodologies that address diagnostic accuracy and indi-viduals’ health outcomes using NANDA International, Nursing Interventions Classification, and Nursing Outcome Classification; as well as implementing studies that evaluate the use of these terminologies for improvements in the efficacy of nurses' interventions and population satisfaction with the nursing process.

Purpose: To develop and validate a tool to evaluate the NANDA International, Inc. diagnostic classification. Methods: The tool, EVALUAN-I, was validated in a non-probabilistic sample (N = 460) on Spanish Registered Nurses (September–December 2019) in two phases. First, design and construct the instrument in three steps: (1) literature review to define the construct focusing on the orientation toward nursing concepts and theoretical foundations, the level of scientific evidence, the structural configuration, the applicability, the nurses’ clinical reasoning skills, and the attitudes toward nursing diagnosis, (2) substantiation of the questionnaire items and design according to the criteria for a diagnostic classification, (3) expert test to establish the face validity and content validity. The second phase revolved around (4) conducting a pilot test and measuring the temporal stability (test-retest) and Cohen's kappa coefficient; assessing psychometric properties by measuring (5) reliability (internal consistency using Cronbach alpha and interfactor correlation) and (6) construct validity (exploratory and confirmatory factor analysis). The manuscript follows the STROBE checklist. The study was approved by the Research Ethics Committee with registration number 2019-190-1. Findings: EVALUAN-I displayed moderate test-retest stability, adequate construct validity, and excellent reliability. The confirmatory factor analysis provided evidence about the configuration of EVALUAN-I in relation to nine analytical dimensions: clinical competence, nurses’ reasoning skills, attitudes towards nursing diagnosis, discipline's central concepts, classification's contents, physiopathological attributes, level of scientific evidence, diagnostic precision, and conceptual correspondence between terminologies. Conclusions: EVALUAN-I is a valid and reliable instrument, which can be used to improve the epistemological, normative, and intuitive configuration of NANDA International, Inc. in a structured, systematic manner. Implications for Nursing Practice: Comprehensive evaluation of NANDA International, Inc. in different clinical settings around the world using a validated instrument, like EVALUAN-I, would allow strengths and weaknesses to be identified and contribute to the classification's development and practical application.

Introduction: nurses have different opinions and attitudes about the clinical functionality of Nursing Diagnosis.Objective: to describe the attitudes of Nursing professionals towards the Nursing Diagnosis.Method: observational, descriptive, cross-sectional study in a hospital in the Canary Islands (Spain). Position on Nursing Diagnosis is a validated instrument to measure the attitudes of nurses towards the Nursing Diagnosis with excellent reliability. It is made up by a coded scale of 20 pairs of opposite adjectives in which the interviewed must position himself; extreme scores 1 (most negative attitude) and 7 (most positive attitude); 4 middle value; 140 maximum score and 20 minimum one. Reliability analysis was performed using Cronbach's alpha and inter-element correlation. Frequency distribution for qualitative variables and proportion for quantitative variables. Association analysis.Results: the study population was N=170. The scale has shown high reliability (α=0.955) as well as adequate power to explain the total variance (66.13%). The global mean score was 74.41 (sd=23.53); the worst attitude was Routine (µ=2.91; sd=1.55) while the best attitude was Positive (µ=4.20; sd=1.56).Conclusions: the attitudes of the nurses in our environment are similar to other contexts, with global scores lower than the average. The increase in academic training and the use of the Nursing Diagnosis in the work environment seem to improve the attitudes of this professionals, mainly with regard to acceptance, comfort, ease, relevance, validity, creativity and gratification. Introducción: Las enfermeras tienen opiniones y actitudes diferentes sobre la funcionalidad clínica de los Diagnósticos Enfermeros.Objetivo: Describir las actitudes de los profesionales de Enfermería ante el Diagnóstico Enfermero.Método: Estudio observacional, descriptivo, transversal en un hospital de las Islas Canarias (España). Position on Nursing Diagnosis constituye un instrumento validado con excelente fiabilidad. Conformado por una escala codificada de 20 parejas de adjetivos opuestos; puntuaciones extremas 1 (más negativa) y 7 (más positiva); valor central 4. Puntuación máxima 140 y mínima 20. Se realizó análisis de fiabilidad mediante Alfa de Cronbach y correlación interelementos. Distribución de frecuencias para variables cualitativas y de proporción para cuantitativas. Análisis de asociación. Resultados: Población muestral n=170. La escala ha expuesto alta fiabilidad (α=0,955) y adecuado poder de explicación de la varianza (66,13%). La puntuación media global fue 74,41 (sd=23,53); la peor actitud correspondió a Rutinario (µ=2,91; sd=1,55) mientras que la mejor fue Positivo (µ=4,20; sd=1,56). Conclusiones: Las actitudes de las enfermeras son similares a las observadas en otras realidades, con puntuaciones globales inferiores a la media. El incremento de la formación académica y del uso del Diagnóstico Enfermero en el entorno laboral parecen mejorar las actitudes de estos profesionales, principalmente en lo que respecta a su aceptación, comodidad, facilidad, relevancia, validez, creatividad y gratificación.

Escape room’s games are educational gamification technologies that consist of introducing a team of players into a physical or digital space to solve a mystery or a problem in search of clues to solve puzzles, riddles, or enigmas. This study aims to determine the effectiveness of escape room’s games on the training of nurses and nursing students. A systematic review was carried out in MEDLINE, WOS, SCOPUS, CINAHL and LILACS databases using the MeSH terms: "Education, Nursing" and "Educational Technology", and the free term "Escape room", combining with Boolean operators AND/OR. Intervention studies in Spanish, English and Portuguese were included, without limitation for the year of publication. Selection and critical appraisal were conducted by two independent reviewers. A total of n=15 interventional studies were included (n=2 Randomized Clinical Trials and n=12 quasi-experimental). Escape rooms are a recent and booming educational methodology, which is increasingly used in academia and training of nurses and nursing students; however, it is necessary to expand their use to more countries, as well as the number and quality of interventional studies, being necessary to homogenize and standardize criteria and to use validated instruments to evaluate the effectiveness of escape rooms in the field of nursing.