Content validation of the defining characteristics of the nursing diagnosis "impaired swallowing" using the Delphi technique: A study with dysphagia nursing experts in Japan.

PURPOSE: Nurses' clinical reasoning skills regarding impaired swallowing can help prevent patient complications and maintain quality of life. Clinical reasoning skills need content-validated defining characteristics (DCs). We aimed to validate the content of these DCs for nursing diagnosis "impaired swallowing." METHODS: Content validation of the DCs was performed by 275 dysphagia nursing experts in Japan, using 3 rounds of the Delphi technique and Fehring's Diagnostic Content Validation (DCV) model. Three rounds of questionnaires on 84 DCs were completed via printed mail. FINDINGS: The valid response rates for each round were as follows: round 1, 90.2%; round 2, 77.8%; and round 3, 71.3%. Of the 84 DCs, 77 that met the consensus criteria were categorized as major (n = 18), minor (n = 45), and excluded (n = 14). There were four minor DCs other than the oral, pharyngeal, and esophageal phases. DCs listed from outside NANDA-I included 12 major, 16 minor, and 3 excluded characteristics. Of the NANDA-I DCs, 5 were no consensus and 11 were excluded. The total DCV score for the 63 major and minor DCs was 0.8. CONCLUSIONS: Our results recommend the addition of 28 DCs and the exclusion of 11 for the NANDA-I nursing diagnosis "impaired swallowing" (00103). Major DCs were prominent indicators of impaired swallowing and signs of aspiration or pharyngeal residuals. Minor DCs included not only the three phases but also other signs necessary for a comprehensive understanding of impaired swallowing. IMPLICATIONS FOR NURSING PRACTICE: This validation study strengthens the clinical usefulness of the DCs for impaired swallowing, which can improve nurses' clinical reasoning skills. Major and minor DCs can increase the awareness of impaired swallowing and enable accurate intervention, thereby preventing patient complications and maintaining quality of life.

Concept analysis of "Insufficient health literacy" in older adults and refinement of a diagnosis proposal.

PURPOSE: This study aims to conduct a thorough analysis of the concept of insufficient health literacy (IHL) in older adults and to refine a nursing diagnosis proposal while considering the specific characteristics of this demographic. METHODS: A comprehensive concept analysis was undertaken using Walker & Avant's method as a framework. FINDINGS: A systematic search across seventeen databases yielded 29 relevant studies for inclusion. Through analysis, we identified 15 antecedents, 3 attributes, and 7 consequents associated with IHL in older adults. CONCLUSIONS: The concept analysis brought clarity to the understanding of IHL within older adults, facilitating the refinement of a diagnosis proposal. This process was instrumental in establishing a diagnostic structure that accounts for the unique needs and challenges faced by older adults. IMPLICATIONS FOR NURSING PRACTICE: The structured diagnosis derived from the concept analysis provides a solid theoretical foundation for nurses specializing in Gerontology. By tailoring care interventions to address the specific requirements of older adults, this framework enhances the quality of nursing practice and contributes to improved patient outcomes in geriatric care settings.

OBJETIVO: Este estudo tem como objetivo realizar uma análise detalhada do conceito de Letramento em saúde insuficiente na população idosa e refinar uma proposta de diagnóstico de enfermagem, levando em consideração as características específicas desse público. MÉTODOS: Foi realizada uma análise conceitual abrangente utilizando o método de Walker & Avant. RESULTADOS: Uma busca sistemática em dezessete bases de dados resultou em 29 estudos relevantes para inclusão. Através da análise, identificamos quinze antecedentes, três atributos e sete consequentes associados ao Letramento em saúde insuficiente na população idosa. CONCLUSÕES: A análise conceitual trouxe clareza à compreensão do Letramento em saúde insuficiente na população idosa, facilitando o refinamento de uma proposta de diagnóstico. Esse processo foi fundamental para estabelecer uma estrutura diagnóstica que considera as necessidades e desafios únicos enfrentados pelos idosos. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O diagnóstico estruturado derivado da análise conceitual fornece uma base teórica sólida para enfermeiros especializados em Gerontologia. Ao adaptar intervenções de cuidados para atender aos requisitos específicos dos idosos, esse framework melhora a qualidade da prática de enfermagem e contribui para resultados de pacientes aprimorados em ambientes de cuidados geriátricos.

Exploring the influence of nursing diagnosis education on Romanian nurses' intention, attitudes, and behavior: a cross-sectional study.

Background and aims: The introduction of accreditation criteria for hospitals has generated increased interest in applying the nursing process to clinical practice and developing nursing care plans. Nursing diagnosis plays a pivotal role in the formulation of these care plans.The objective of the study is to investigate the correlation between nursing diagnosis education and nurses' intentions, attitudes toward the use of nursing diagnosis and the behavior in using it in practice; to explore the differences between nurses' intentions, attitudes and behavior, considering nurses' socio-demographic and professional data. Methods: A cross-sectional design was used. A web-based survey was applied to gather data. A sample of 664 hospital nurses was recruited from five Romanian hospitals. Results: Education on nursing diagnosis showed significant results in relation to nurses' intentions (F(2,126.35) = 23.99, p < 0.001), attitudes (χ2 (2, N = 664) = 44.62, p < 0.001) and behavior (F(2,167.69) = 29.53, p < 0.001) in using it in clinical practice. Nurses with education highly focused on nursing diagnosis have significantly stronger intention to use it, more positive attitudes and higher behavior in using it in clinical practice compared to nurses whose education simply had included a nursing diagnosis course, or nurses without any education on the topic. Significant differences were identified in intention (t (83.86) = -4.49, p < 0.001) and attitudes (U = 12697.50, z = -3.99, p < 0.001, r = -0.0006) of management nurses compared to clinical nurses. Conclusion: Nursing education on nursing diagnosis significantly impacts nurses' intentions, attitudes, and behavior in their daily practice. Romanian nurses display slightly positive intention and attitudes toward nursing diagnosis but need more training for effective/practical clinical application.

Nursing diagnoses and hospital readmission of patients with respiratory diseases: Findings from a case-control study.

AIM: The rate of readmission after hospitalisation for respiratory diseases has become a common and challenging clinical problem. Social and functional patient variables could help identify cases at high risk of readmission. The aim was to identify the nursing diagnoses that were associated with readmission after hospitalisation for respiratory disease in Spain. DESIGN: Case-control study within the cohort of patients admitted for respiratory disease during 2016-19 in a tertiary public hospital in Spain (n = 3781). METHODS: Cases were patients who were readmitted within the first 30 days of discharge, and their controls were the remaining patients. All nursing diagnoses (n = 130) were collected from the electronic health record. They were then grouped into 29 informative diagnostic categories. Clinical confounder-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using logistic regression models. RESULTS: The readmission rate was 13.1%. The nursing diagnoses categories 'knowledge deficit' (OR: 1.61; 95%CI: 1.13-2.31), 'impaired skin integrity and risk of ulcer infection' (OR: 1.45; 95%CI: 1.06-1.97) and 'activity intolerance associated with fatigue' (OR: 1.56; 95%CI: 1.21-2.01) were associated with an increased risk of suffering an episode of hospital readmission rate at 30% after hospital discharge, and this was independent of sociodemographic background, care variables and comorbidity. PATIENT OR PUBLIC CONTRIBUTION: The nursing diagnoses assigned as part of the care plan of patients during hospital admission may be useful for predicting readmissions.

Clinical validity of the nursing diagnosis risk for unstable blood glucose level in persons with type 2 diabetes mellitus: A case-control study.

OBJECTIVE: To assess clinical-causal validity evidence of the nursing diagnosis, risk for unstable blood glucose level (00179), in individuals with type 2 diabetes mellitus. METHODS: A case-control study was conducted in 5 primary healthcare units, involving 107 subjects with type 2 diabetes mellitus, 60 in the case group and 47 in the control group. Causality was determined by the association between sociodemographic and clinical factors, risk factors related to the nursing diagnosis, and the occurrence of unstable blood glucose level. An association was considered when the risk factor had a p-value of <0.05 and odds ratio >1. RESULTS: Risk factors, such as stress, inadequate physical activity, and low adherence to therapeutic regimen, were prevalent in the sample. Time since diagnosis between 1-5 and 6-10 years, multiracial ethnicity, and the risk factor of low adherence to therapeutic regimen increased the likelihood of the outcome. Completion of high school education was identified as a protective factor. CONCLUSIONS: The clinical validation of the nursing diagnosis, risk for unstable blood glucose level, has been successfully established, revealing a clear association between sociodemographic and clinical factors and the risk factors inherent to the nursing diagnosis. IMPLICATIONS FOR NURSING PRACTICE: The results contribute to advancing scientific knowledge related to nursing education, research, and practice and provide support for the evolution of nursing care processes for individuals with type 2 diabetes mellitus.

OBJETIVO: Avaliar a evidência de validade clínico­causal do diagnóstico de enfermagem, risco para nível instável de glicose no sangue (00179), em indivíduos com diabetes mellitus tipo 2. MÉTODO: Foi realizado um estudo caso­controle em cinco unidades básicas de saúde, envolvendo 107 indivíduos com diabetes mellitus tipo 2, 60 no grupo caso e 47 no grupo controle. A causalidade foi determinada pela associação entre fatores sociodemográficos e clínicos, fatores de risco relacionados ao diagnóstico de enfermagem e a ocorrência de nível instável de glicose no sangue. Uma associação foi considerada quando o fator de risco tinha um valor de p < 0.05 e odds ratio > 1. RESULTADOS: Fatores de risco como estresse, atividade física inadequada e baixa adesão ao regime terapêutico foram predominantes na amostra. O tempo desde o diagnóstico entre 1 e 5 anos e 6 a 10 anos, a etnia parda e o fator de risco baixa adesão ao regime terapêutico aumentaram a probabilidade do resultado. A conclusão do ensino médio foi identificada como um fator de proteção. CONCLUSÕES: A validação clínica do diagnóstico de enfermagem, risco para nível instável de glicose no sangue, foi estabelecida com sucesso, revelando uma clara associação entre fatores sociodemográficos e clínicos e os fatores de risco inerentes ao diagnóstico de enfermagem. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os resultados contribuem para o avanço do conhecimento científico relacionado à educação, à pesquisa e à prática de enfermagem e fornecem suporte para a evolução dos processos de cuidados de enfermagem para indivíduos com diabetes.

Prevalence of NANDA-I Nursing Diagnoses in patients with heart failure: A systematic review and meta-analysis.

AIM: This research quantitatively explored the prevalence of NANDA-I nursing diagnoses related to the care of patients experiencing heart failure. DESIGN: A systematic review and meta-analysis were conducted with the systematic review protocol registered in PROSPERO (registration number: CRD42022382565). METHODS: Systematic searches were performed between March and April 2022, including peer review for selection, quality assessment, data extraction, and analysis of all included studies. A subsequent meta-analysis was performed, focusing on the proportion of nursing diagnoses in patients with heart failure. The logistic random effects model with maximum likelihood estimation assessed the combined proportion, and heterogeneity between studies was evaluated using the I2 statistic. The goodness-of-fit of the meta-analysis results was assessed using the leave-one-out method and by evaluating publication bias through contour-enhanced funnel plots. DATA SOURCES: PubMed, SCOPUS, CINAHL, WOS, and Embase were used. RESULTS: Of the 11 studies that met the eligibility criteria, 44 nursing diagnoses were identified as most frequently occurring in patients experiencing heart failure, and only 16 diagnoses appeared in more than one publication. The combined mean proportion was 35.73% (95% CI = [26.67%; 48.56%]), indicating the presence of heterogeneity based on the I2 value. However, no publication bias was observed. CONCLUSION: The results of the meta-analysis suggest priority diagnoses in individuals with heart failure, such as deficient knowledge (00126). Additionally, secondary diagnoses, such as activity intolerance (00092), excess fluid volume (00026), and ineffective breathing pattern (00032), were identified as responses to decreased cardiac output (00029). Less prevalent nursing diagnoses were associated with deterioration of health status and the need for hospitalization. OBJETIVO: Investigar cuantitativamente la prevalencia de diagnósticos de enfermería NANDA-I asociados con la atención de pacientes con insuficiencia cardíaca. DISEÑO: Revisión sistemática y metanálisis. El protocolo de revisión sistemática quedó registrado en PROSPERO) número de registro: CRD42022382565). MÉTODOS: Se realizaron búsquedas sistemáticas entre marzo y abril de 2022, llevándose a cabo una revisión por pares sobre la selección, evaluación de calidad, extracción de datos y análisis de todos los estudios incluidos. Se realizó un metanálisis posterior centrado en la proporción de diagnósticos de enfermería en pacientes con insuficiencia cardíaca. El modelo logístico de efectos aleatorios con estimación de máxima verosimilitud evaluó la proporción combinada y la heterogeneidad entre los estudios se evaluó mediante el estadístico I2. La bondad de ajuste de los resultados del metanálisis se evaluó mediante el método Leave-one-out y la evaluación del sesgo de publicación mediante gráficos de embudo (funnel plot), denominado Contour-Enhanced Funnel Plot. FUENTES DE DATOS: PubMed, SCOPUS, CINAHL, WOS, Embase. RESULTADOS: En los 11 estudios que cumplieron con los criterios de elegibilidad, se identificaron 44 diagnósticos de enfermería aunque sólo 16 diagnósticos aparecieron en más de una publicación. La proporción media combinada fue del 35,73% (IC del 95%) = [26,67%; 48,56%]), y el valor de I2 indica la presencia de heterogeneidad, aunque no hay sesgo de publicación. CONCLUSIÓN: Los resultados de este metaanálisis indican que habría diagnósticos prioritarios en personas con insuficiencia cardíaca, como Conocimientos deficientes (00126). Además, se han identificado otros diagnósticos de enfermería como diagnósticos secundarios: Intolerancia a la actividad (00092), Exceso de volumen de líquidos (00026) y Patrón respiratorio ineficaz (00032), que sería la respuesta a Disminución del gasto cardíaco (00029). Además de diagnósticos de enfermeríaa menos prevalentes relacionados con el deterioro del estado de salud y la necesidad de hospitalización.

Middle-Range Theory of Occupational Stress in Health Professionals.

Introduction: Occupational stress affects health professionals; however, no literature was found on the middle-range theory for this outcome in health professionals. Methods: Methodological study for the theoretical validation of a nursing diagnosis using the theoretical framework of Walker and Avant and the Betty Neuman systems models. The research was conducted in five stages: comprehension of the system model; selection and review of studies; development of the conceptual-theoretical-empirical structure; elaboration of a diagram and proposition of a nursing diagnosis; and evaluation of the empirical adequacy of the theory and validity of the system model. These steps were conducted using a scoping review and a sample of 138 articles selected in the Scopus, Web of Science, MEDLINE/PubMed, CINAHL, PsycINFO, LILACS, Science Direct, Cochrane Library, and Google Scholar databases. A data extraction instrument was developed, and study variables (attributes, antecedents, and clinical consequences) were analyzed using descriptive statistics (absolute and relative frequencies) and presented in tables. Results: The middle-range theory comprised 16 concepts, 20 propositions, and one diagram. A total of 15 related factors, 29 defining characteristics, six at-risk populations, and one associated condition were indicated to propose the nursing diagnosis for occupational stress. Conclusion: The middle-range theory supported elaborating elements to propose a nursing diagnosis for occupational stress.

Nursing diagnoses in patients with COVID-19 admitted to the intensive care unit: CROSS-MAPPING.

To identify and analyze the nursing diagnoses listed in the medical records of COVID-19 patients admitted to an intensive care unit using Taxonomy II of NANDA-I. Background: COVID-19 is a complex disease with heterogeneous behaviors, and the role of intensive care nurses in accurately identifying related signs and symptoms has become even more critical during the pandemic. Nurses rely on classification systems or taxonomies to standardize concepts and language in practice. Method: This quantitative study employed a descriptive and individual approach, utilizing the cross-mapping method. Data were collected from 57 medical records of critical care patients in a hospital in northeastern Brazil between July 2020 and March 2021. Three researchers analyzed the mapped diagnoses, and agreement was assessed using the Content Validation Index and Fleiss' Kappa. Results: Among the listed nursing diagnoses, 54.28% were found to be standardized, 45.71% had corresponding nursing diagnoses, and 5.71% did not have an equivalent diagnosis in the reference taxonomy used in the study. Due to the possibility of multiple nursing diagnoses in the same patient, the most frequent diagnoses were Risk of pressure injury in adults (66.66%), Risk of falls in adults (64.91%), and Risk of infection (45.61%). Among the 37 diagnoses mapped, the risk diagnoses were the most prevalent and could be prevented if identified early. Conclusions: The study highlights the importance of standardized nursing diagnoses in the ICU for COVID-19 patients and the need for accurate identification and prevention of risk diagnoses to enhance patient care and improve outcomes.

Using Principles of Digital Development for a Smartphone App to Support Data Collection in Patients With Acute Myocardial Infarction and Physical Activity Intolerance: Case Study.

BACKGROUND: Advances in health have highlighted the need to implement technologies as a fundamental part of the diagnosis, treatment, and recovery of patients at risk of or with health alterations. For this purpose, digital platforms have demonstrated their applicability in the identification of care needs. Nursing is a fundamental component in the care of patients with cardiovascular disorders and plays a crucial role in diagnosing human responses to these health conditions. Consequently, the validation of nursing diagnoses through ongoing research processes has become a necessity that can significantly impact both patients and health care professionals. OBJECTIVE: We aimed to describe the process of developing a mobile app to validate the nursing diagnosis "intolerance to physical activity" in patients with acute myocardial infarction. METHODS: We describe the development and pilot-testing of a mobile system to support data collection for validating the nursing diagnosis of activity intolerance. This was a descriptive study conducted with 11 adults (aged ≥18 years) who attended a health institution for highly complex needs with a suspected diagnosis of coronary syndrome between August and September 2019 in Floridablanca, Colombia. An app for the clinical validation of activity intolerance (North American Nursing Diagnosis Association [NANDA] code 00092) in patients with acute coronary syndrome was developed in two steps: (1) operationalization of the nursing diagnosis and (2) the app development process, which included an evaluation of the initial requirements, development and digitization of the forms, and a pilot test. The agreement level between the 2 evaluating nurses was evaluated with the κ index. RESULTS: We developed a form that included sociodemographic data, hospital admission data, medical history, current pharmacological treatment, and thrombolysis in myocardial infarction risk score (TIMI-RS) and GRACE (Global Registry of Acute Coronary Events) scores. To identify the defining characteristics, we included official guidelines, physiological measurements, and scales such as the Piper fatigue scale and Borg scale. Participants in the pilot test (n=11) had an average age of 63.2 (SD 4.0) years and were 82% (9/11) men; 18% (2/11) had incomplete primary schooling. The agreement between the evaluators was approximately 80% for most of the defining characteristics. The most prevalent characteristics were exercise discomfort (10/11, 91%), weakness (7/11, 64%), dyspnea (3/11, 27%), abnormal heart rate in response to exercise (2/10, 20%), electrocardiogram abnormalities (1/10, 9%), and abnormal blood pressure in response to activity (1/10, 10%). CONCLUSIONS: We developed a mobile app for validating the diagnosis of "activity intolerance." Its use will guarantee not only optimal data collection, minimizing errors to perform validation, but will also allow the identification of individual care needs.

Content analysis of the nursing diagnosis of ineffective peripheral tissue perfusion in patients with diabetic foot.

AIM: To analyse the content of the nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. DESIGN: A methodological study with a quantitative approach was performed. METHODS: The analysis was performed between January and May 2021 by 34 nurses with clinical/theoretical/research experience with diabetes or nursing diagnoses. These nurses evaluated the relevance, clarity and precision of 12 diagnosis-specific etiological factors, 22 clinical indicators and their conceptual and operational definitions. FINDINGS: All 12 etiological factors analysed were considered relevant to diagnostic identification. However, five showed inconsistencies regarding the clarity or precision of the operational definitions, requiring adjustments. Regarding the 22 clinical indicators evaluated, all of them presented a Content Validity Index (CVI) that was statistically significant. However, in the indicators, the colour does not return to lowered limb after 1 min of leg elevation, and cold foot had Content Validity Index (CVI) <0.9 regarding relevance and accuracy of operational definitions. CONCLUSIONS: Twelve etiological factors and 22 clinical indicators were validated. Thus, this study revealed new and relevant aspects characterising peripheral perfusion in patients with diabetic foot that have not yet been clinically validated. IMPLICATIONS FOR NURSING PRACTICE: This study contributes to support the professional practice of nurses through the early identification of etiological factors and clinical indicators in persons with diabetic foot. As a proposal, we suggest the inclusion of new defining characteristics and related factors for the nursing diagnosis ineffective peripheral tissue perfusion in the NANDA-I taxonomy. IMPACT: The research highlights new and relevant aspects such as etiological factors and clinical indicators to characterise peripheral perfusion in patients with diabetic foot. Based on these findings, clinical validation is recommended to confirm the relevance of the proposed elements in the population studied for greater reliability and improved diagnostic assessment for the professional practice of nurses. REPORTING METHOD: EQUATOR guidelines were adhered to using the GRRAS checklist for reporting reliability and agreement studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Evidence of content validity of the nursing diagnosis risk for unstable blood pressure.

PURPOSE: To analyze evidence of content validity of the nursing diagnosis (ND) Risk for Unstable Blood Pressure in incarcerated women.  METHOD: A methodological study assessing the content validity of an ND, was performed in Brazil, between June and September 2022, with 49 nurses as experts. The label, definition, and relevance of the 19 risk factors of the ND Risk for Unstable Blood Pressure were appraised. Based on the predictive diversity model, the content validity index (CVI) and respective 95% confidence intervals were calculated for each risk factor. A CVI ≥ 0.8 was considered adequate evidence of content validity. FINDINGS: The label and the definition of the diagnosis was reformulated. The relevance of 19 etiological factors showed a CVI ≥ 0.8. According to the recommendation of the panel of experts, one of the etiological factors was split in two and two label of etiological factors were changed. CONCLUSIONS: A new label (Risk for Imbalanced Blood Pressure), new definition, and 20 etiological factors (11 risk factors, five associated conditions, and four at-risk populations) of the ND Risk for Unstable Blood Pressure in incarcerated women were considered valid. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I accepted the proposal for this nursing diagnosis; hence this study contributed to updating the classification based on scientific evidence. This evidence will favor diagnostic reasoning and recognition of the diagnosis during clinical assessment, and support studies assessing the clinical validity of these elements in incarcerated women.

OBJETIVO: Analisar evidências de validade de conteúdo do diagnóstico de enfermagem (DE) Risco de Pressão Arterial Instável em mulheres encarceradas. MÉTODO: Estudo metodológico de validade de conteúdo de um DE, realizado no Brasil, entre junho e setembro de 2022, tendo 49 enfermeiros como experts. Foram avaliados o título, a definição e a relevância dos 19 fatores de risco do DE Risco de Pressão Arterial Instável. Com base no modelo de diversidade preditiva, foram calculados o Índice de Validade de Conteúdo (IVC) e respectivos intervalos de confiança de 95% para cada fator de risco. IVC ≥ 0,8 foi considerado evidência adequada de validade de conteúdo. RESULTADOS: A relevância de 19 fatores etiológicos mostrou IVC ≥ 0,8. De acordo com a recomendação do painel de experts, um dos fatores etiológicos foi dividido em dois e dois rótulos de fatores etiológicos foram alterados. O título e a definição do diagnóstico foram reformulados. CONCLUSÃO: Foram considerados válidos um novo título (Risco de pressão arterial desequilibrada), nova definição e 20 fatores etiológicos (11 fatores de risco, cinco condições associadas e quatro populações de risco) do DE Risco de Pressão Arterial Instável em mulheres encarceradas. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A NANDA-I aceitou a proposta deste diagnóstico de enfermagem; portanto, este estudo contribuiu para a atualização da classificação baseada em evidências científicas. Essas evidências favorecerão o raciocínio diagnóstico e o reconhecimento do diagnóstico durante a avaliação clínica, além de subsidiar estudos que avaliem a validade clínica desses elementos em mulheres encarceradas.

Definition and validation of the nursing diagnosis label "wish to die": a research protocol.

BACKGROUND: Euthanasia has been incorporated into the health services of seven countries. The legalisation of these practices has important repercussions for the competences of nurses, and it raises questions about their role. When a patient with advanced disease expresses a wish to die, what is expected of nurses? What are the needs of these patients, and what kind of care plan do they require? What level of autonomy might nurses have when caring for these patients? The degree of autonomy that nurses might or should have when it comes to addressing such a wish and caring for these patients has yet to be defined. Recognising the wish to die as a nursing diagnosis would be an important step towards ensuring that these patients receive adequate nursing care. This study-protocol aims to define and validate the nursing diagnosis wish to die in patients with advanced disease, establishing its defining characteristics and related factors; to define nursing-specific interventions for this new diagnosis. METHODS: A prospective three-phase study will be carried out. Phase-A) Foundational knowledge: an umbrella review of systematic reviews will be conducted; Phase-B) Definition and validation of the diagnostic nomenclature, defining characteristics and related factors by means of an expert panel, a Delphi study and application of Fehring's diagnostic content validation model; Phase-C) Definition of nursing-specific interventions for the new diagnosis. At least 200 academic and clinical nurses with expertise in the field of palliative care or primary health care will be recruited as participants across the three phases. DISCUSSION: The definition of the wish to die as a nursing diagnosis would promote greater recognition and autonomy for nurses in the care of patients who express such a wish, providing an opportunity to alleviate underlying suffering through nursing-specific interventions and drawing attention to the needs of patients with advanced disease. The new diagnosis would be an addition to nursing science and would provide a framework for providing care to people with advanced disease who express such a wish. Nurses would gain professional autonomy about identifying, exploring and responding clinically to such a wish.

Prevalence and clustering of NANDA-I nursing diagnoses in the pre-hospital emergency care setting: A retrospective records review study.

AIM: To determine the prevalence and clustering of NANDA-International nursing diagnoses in patients assisted by pre-hospital emergency teams. DESIGN: Retrospective descriptive study of electronic record review. METHODS: Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two-step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. RESULTS: Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six-cluster solution (n = 26.788) was found. Five clusters had a single high-prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co-occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). CONCLUSION: Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre-hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre-hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre-hospital clinical setting. IMPACT: What problem did the study address? There are different models of pre-hospital emergency care services. The use of standardized nursing languages in the pre-hospital setting is not homogeneous. Studies on NANDA-I nursing diagnoses in the pre-hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA-I nursing diagnoses in the pre-hospital care setting. Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance. Patients attended by pre-hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre-hospital setting, increasing the evidence of individualized and standardized care plans for pre-hospital care. REPORTING METHOD: STROBE checklist has been used as a reporting method. NO PATIENT OR PUBLIC CONTRIBUTION: Only patients' records were reviewed without further involvement.

Compromised end-of-life syndrome in cancer patients: A clinical validation study.

PURPOSE: To identify the prevalence of the nursing diagnosis of compromised end-of-life syndrome in patients in end-of-life care. METHODS: This is a clinical validation based on a cross-sectional epidemiological clinical study conducted at the National Cancer Institute in Rio de Janeiro, Brazil. The defining characteristics of a syndrome diagnosis were identified, defined as a "subset of nursing diagnoses," using sensitivity and specificity measures through the application of latent class statistical methods. FINDINGS: The statistical results revealed seven nursing diagnoses characterizing the syndrome: imbalanced nutrition: less than body requirements, nausea, anxiety, ineffective breathing pattern, disturbed sleep pattern, ineffective thermoregulation, and fatigue. Compromised end-of-life syndrome was present in 76% of the sample. CONCLUSION: The study demonstrated the presence of compromised end-of-life syndrome in most end-of-life patients from the sample. IMPLICATIONS FOR NURSING PRACTICE: Recognizing the presence of the syndrome diagnosis enables nurses to have efficient and effective clinical reasoning for implementing the nursing process in palliative care. CAAE Number: 85415618.0.3001.5274.

OBJETIVO: Identificar a prevalência do diagnóstico de enfermagem Síndrome de fim de vida comprometido em pacientes em cuidados de fim de vida. MÉTODO: Trata-se de uma validação clínica baseada em um estudo clínico epidemiológico transversal, desenvolvido no Instituto Nacional do Câncer no Rio de Janeiro, Brasil. Foram identificadas as características definidoras de um diagnóstico de síndrome, definido como um "subconjunto de diagnósticos de enfermagem" utilizando-se medidas de sensibilidade e especificidade a partir da aplicação do método estatístico de classe latente. RESULTADOS: Os resultados estatísticos identificaram sete diagnósticos de enfermagem caracterizadores da síndrome: nutrição desequilibrada: menor que as necessidades corporais, náusea, ansiedade, padrão respiratório ineficaz, padrão de sono perturbado, termorregulação ineficaz e fadiga. O diagnóstico Síndrome de fim de vida comprometido esteve presente em 76% da amostra. CONCLUSÃO: O estudo demonstrou a presença da Síndrome de fim de vida comprometido na maioria dos pacientes em cuidados de fim de vida da amostra. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O reconhecimento da presença do diagnóstico de síndrome permite ao enfermeiro um raciocínio clínico eficaz e eficiente para a implantação do processo de enfermagem em cuidados paliativos. Número CAAE: 85415618.0.3001.5274.

The ChatGPT effect and transforming nursing education with generative AI: Discussion paper.

AIM: The aim of this study is to present the possibilities of nurse education in the use of the Chat Generative Pre-training Transformer (ChatGPT) tool to support the documentation process. BACKGROUND: The success of the nursing process is based on the accuracy of nursing diagnoses, which also determine nursing interventions and nursing outcomes. Educating nurses in the use of artificial intelligence in the nursing process can significantly reduce the time nurses spend on documentation. DESIGN: Discussion paper. METHODS: We used a case study from Train4Health in the field of preventive care to demonstrate the potential of using Generative Pre-training Transformer (ChatGPT) to educate nurses in documenting the nursing process using generative artificial intelligence. Based on the case study, we entered a description of the patient's condition into Generative Pre-training Transformer (ChatGPT) and asked questions about nursing diagnoses, nursing interventions and nursing outcomes. We further synthesized these results. RESULTS: In the process of educating nurses about the nursing process and nursing diagnosis, Generative Pre-training Transformer (ChatGPT) can present potential patient problems to nurses and guide them through the process from taking a medical history, setting nursing diagnoses and planning goals and interventions. Generative Pre-training Transformer (ChatGPT) returned appropriate nursing diagnoses, but these were not in line with the North American Nursing Diagnosis Association - International (NANDA-I) classification as requested. Of all the nursing diagnoses provided, only one was consistent with the most recent version of the North American Nursing Diagnosis Association - International (NANDA-I). Generative Pre-training Transformer (ChatGPT) is still not specific enough for nursing diagnoses, resulting in incorrect answers in several cases. CONCLUSIONS: Using Generative Pre-training Transformer (ChatGPT) to educate nurses and support the documentation process is time-efficient, but it still requires a certain level of human critical-thinking and fact-checking.

Accuracy of the defining characteristics of the nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot.

OBJECTIVE: To evaluate the accuracy of the defining characteristics of the nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. METHOD: A diagnostic accuracy study with a cross-sectional design was carried out with patients with type 2 diabetes mellitus on outpatient diabetic foot treatment. We evaluated 134 patients with diabetic foot to determine the accuracy of the defining characteristics of ineffective peripheral tissue perfusion. A latent class model with random effects was used to establish the sensitivity and specificity of the defining characteristics assessed. RESULTS: Ineffective peripheral tissue perfusion was present in 83.79% of the patients. The defining characteristics color does not return to lowered limb after 1-minute leg elevation and edema had high sensitivity (0.8370 and 0.7213) and specificity (0.9991 and 0.9995). CONCLUSION: The defining characteristics color does not return to lowered limb after 1-minute leg elevation and edema are good clinical indicators that can be used for screening and confirming ineffective peripheral tissue perfusion in patients with diabetic foot.

Evaluation of the use of a nursing diagnosis Risk for Falls in the Community of Madrid (Spain) Primary Care System.

PURPOSE: The purpose of this study was to describe the use of the nursing diagnosis Risk for Falls in Primary Care System of the Community of Madrid. METHODS: A retrospective review of the clinical histories was carried out in 262 health centers from January 2005 to December 2015. The study population are the patients who have recorded in their electronic health record the nursing diagnosis Risk for Falls. FINDINGS: Frequency of use of the Risk for Falls ND in the Community of Madrid was 53,340 diagnoses, increasing from 650 nursing diagnosis in 2005 to 14,695 in 2015. NOC Nursing Outcomes total identified were 109,145, which represents an average of 2.05 NOC Nursing Outcomes per diagnosis. NOC Nursing Outcomes frequently appeared as follows: Fall Prevention Behavior (35.9%), Safe Home Environment (11.3%), and Risk Control (10.5%). NIC Nursing Interventions total identified were 104,293, representing an average of 1.96 NIC nursing interventions per diagnosis. NIC Nursing Interventions frequently appeared as follows: Fall Prevention (45.9%), Environmental Management: Safety (27%), and Risk Identification (5.8%). CONCLUSIONS: Nursing diagnosis of Risk for Falls and the care process related to this diagnosis is starting to be used by the primary care nurses of the Community of Madrid. IMPLICATION FOR NURSING PRACTICE: Risk factors related to the nursing diagnosis of risk for falls identified in our study can be addressed with activities that nurses must implement to prevent falls. Nursing methodology in general and specifically the diagnosis of risk for falls must be included in guides and protocols for the prevention of falls, and its use should be promoted by primary care nurses.

Identification of North American Nursing Diagnosis Association-Nursing Interventions Classification-Nursing Outcomes Classification of nursing home residents using on-time data by android smartphone application by registered nurses.

PURPOSE: We aimed to investigate the nursing process linkages formed by Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) according to the primary NANDA-I diagnoses by registered nurses (RNs), customized to nursing home (NH) residents in Korea, using a developed smartphone application for NH RNs. METHODS: This is a retrospective descriptive study. Applying quota sampling, a total of 51 NHs from all operating 686 NHs hiring RNs participated in this study. Data were collected from June 21 to July 30, 2022. Data on NANDA-I, NIC, NOC (NNN) of nurses applied to the NH residents were collected through a developed smartphone application. The application consists of general organization and residents' characteristics, NANDA-I, NIC, and NOC. RNs selected randomly up to 10 residents and NANDA-I with risk factors and related factors over the past 7 days, followed by all applied interventions out of 82 NIC. RNs then evaluated residents through 79 selected NOC. RESULTS: We found the frequently used NANDA-I diagnoses, Nursing Interventions Classifications and Nursing Outcomes and Classifications applied for NH residents by RNs and developed the top five NOC linkages used to build care plan. CONCLUSION: It is time to pursue high-level evidence and reply to the questions raised in NH practice using NNN with high technology. The outcomes for patients and nursing staff are improved by the continuity of care made possible by uniform language. IMPLICATIONS FOR NURSING PRACTICE: NNN linkages should be used to construct and utilize the coding system of electronic health records or electronic medical records in Korean long-term care facilities.

Analysis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus.

PURPOSE: To estimate the prevalence of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus through the diagnostic accuracy of the defining characteristics. METHODS: A diagnostic accuracy study on the diagnosis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus was conducted using the latent class analysis model. The sample comprised 180 individuals attending a referral outpatient clinic in Maranhão, Brazil. The data analysis was conducted in the R Core Team software. FINDINGS: The prevalence of the nursing diagnosis was 55.23%. The main defining characteristics were expresses desire to enhance health communication with healthcare providers and expresses desire to enhance the understanding of health information to make healthcare choices. All defining characteristics showed significant specificity values. CONCLUSIONS: Accurate diagnoses contribute to individualized care plans for patients. IMPLICATIONS FOR NURSING PRACTICE: The diagnosis Readiness for enhanced health literacy should be considered in implementing care plans, including interventions to reduce complications in the health status of patients with type 2 diabetes mellitus.

Deficient knowledge in patients with heart failure: A study of diagnostic accuracy and etiological relationships.

PURPOSE: To evaluate the accuracy of defining characteristics and causal relationships of the etiological factors of the nursing diagnosis deficient knowledge in individuals with heart failure . DATA SOURCES: An analytical, cross-sectional study on the diagnostic accuracy of the defining characteristics and causal relationships of the etiological factors of the nursing diagnosis. The sample consisted of 140 patients with chronic HF and in outpatient follow-up. The latent class analysis method was used to test the accuracy of measurements and estimate the prevalence of the diagnosis. The calculation of subsequent probabilities and the odds ratio ( were also parameters employed. The study was approved by the Research Ethics Committee of the Federal University of Pernambuco. DATA SYNTHESIS: The diagnosis had an estimated prevalence of 38.57% in the sample. The inaccurate statements about the disease and/or therapy, self-care deficient performance, and inadequate behavior were the clinical indicators that best predicted the presence of the diagnosis and demonstrated the same sensitivity value (1.0000), specificity (1.0000), and 95% confidence interval (0.9999-1.0000) for all. The populations at risk was elderly (OR = 2.12, confidence interval 95% = 1.05-4.27), and illiterate individuals (OR = 2.07, confidence interval 95% = 1.03-4.16) had an approximately twofold great chance of developing havening deficient knowledge. CONCLUSION: The evaluation of the accuracy of clinical indicators, corresponding to the defining characteristics in the study, contributed to screening and diagnostic establishment capacity in clinical practice, and to the translation of theoretical and practical knowledge. IMPLICATIONS FOR NURSING PRACTICE: Accurate clinical indicators of the nursing diagnosis deficient knowledge facilitate the clinical reasoning of nurses and favor the professional's role in the development of health education strategies focused on the acquisition of knowledge about the disease by patients, family members, and caregivers.

OBJETIVO: Avaliar a acurácia das características definidoras e relações causais dos fatores etiológicos do diagnóstico de enfermagem Conhecimento deficiente em pacientes com insuficiência cardíaca. FONTE DE DADOS: Estudo analítico, transversal, sobre a acurácia diagnóstica das características definidoras e relações causais dos fatores etiológicos do diagnóstico de enfermagem. A amostra foi composta por 140 pacientes com insuficiência cardíaca crônica e em acompanhamento ambulatorial. O método de análise de classes latentes foi utilizado para testar as medidas de acurácia e estimar a prevalência do diagnóstico. O cálculo de probabilidades posteriores e a Odds Ratio também foram parâmetros empregados. O estudo teve aprovação do Comitê de Ética em Pesquisa da Universidade Federal de Pernambuco. SÍNTESE DE DADOS: O diagnóstico apresentou prevalência estimada de 38,57% na população. As Declarações imprecisas sobre a doença e/ou terapêutica, Déficit no desempenho do autocuidado e Comportamento inadequado foram os indicadores clínicos que melhor predisseram a presença do diagnóstico e demonstraram o mesmo valor de sensibilidade (1.0000), especificidade (1.0000) e intervalo de confiança 95% (0.9999­1.0000) para todos. As populações em risco Idoso (Odds Ratio = 2.12, intervalo de confiança 95% = 1.05­4.27) e Indivíduos analfabetos (Odds Ratio = 2.07, intervalo de confiança 95% = 1.03­4.16) apresentaram, aproximadamente, duas vezes a chance de desenvolver o conhecimento deficiente. CONCLUSÃO: A avaliação da acurácia dos indicadores clínicos, correspondentes as características definidoras no estudo, contribuiu para a capacidade de triagem e estabelecimento de diagnósticos na prática clínica e para a tradução de conhecimentos teóricos e práticos. IMPLICAÇÕES PARA PRÁTICA DE ENFERMAGEM: Indicadores clínicos acurados do diagnóstico de enfermagem Conhecimento deficiente facilitam o raciocínio clínico do enfermeiro e favorecem a atuação do profissional na elaboração de estratégias de educação em saúde focadas na aquisição do conhecimento sobre a doença por parte de pacientes, familiares e cuidadores.