Clinical Validation of the Nursing Diagnosis 'Inadequate Health Self-Efficacy' in People With Hypertension.

AIMS: To test the clinical validity of clinical indicators and causal relationships of aetiological factors of the new nursing diagnosis of inadequate health self-efficacy in people with hypertension. BACKGROUND: The diagnosis of inadequate health self-efficacy has both theoretical and content validity. However, a clinical validation study is needed to establish an appropriate framework for distinguishing individuals who manifest this unique human response. DESIGN: The study adopts a cross-sectional clinical validation approach, adhering strictly to the STROBE guidelines throughout its design and implementation. METHODS: Naturalistic sampling was used to identify 302 adults diagnosed with hypertension. Their data were subjected to latent class analysis, which facilitated the identification of a comprehensive set of clinical indicators that demonstrated better diagnostic accuracy and established posterior probabilities to guide the inference of inadequate health self-efficacy. In addition, logistic regression analysis was used to assess the magnitude of the impact of aetiological factors. RESULTS: The prevalence of inadequate health self-efficacy was 76.61%. Among the 13 indicators examined, seven demonstrated notable sensitivity: 'risk-prone health behaviour', 'failure to take action that prevents health problems', 'inadequate self-control', 'avoidance behaviours', 'negative health self-perception', 'inadequate health-related quality of life' and 'difficulty feeling good about adopting a healthy lifestyle'. Additionally, two indicators showed high specificity: 'difficulty feeling good about adopting a healthy lifestyle' and 'inadequate adherence to treatment regimen'. Notably, 15 aetiological factors were identified as significantly associated with an increased risk of inadequate health self-efficacy. CONCLUSIONS: A clinical framework consisting of eight clinical indicators and 15 aetiological factors was developed to characterise inadequate health self-efficacy in individuals with hypertension. RELEVANCE TO PRACTICE: Clinical validation provides insight into the precision of clinical indicators and the magnitude of the effect of putative causal elements, thereby facilitating identification and tailored intervention for individuals with hypertension and inadequate health self-efficacy.

Content validation of the NANDA-I nursing diagnosis risk for perioperative hypothermia (00254).

PURPOSE: The objectives of this study were to refine and validate the NANDA-I nursing diagnosis risk for perioperative hypothermia (RPH) (00254). METHODS: A quantitative, descriptive study was carried out according to the adapted diagnostic content validation model by Fehring. Data from a previously conducted literature study were triangulated with expert validation data to examine the nursing diagnosis RPH as well as potentially suggested new factors resulted from the literature review. In addition, the Wisdom of Crowds model was also considered. A nonprobability sampling technique, including purposive and snowball sampling methods, was used to recruit a panel of nurse experts. An anonymous and standardized questionnaire was developed in three languages for data collection. For validation, descriptive statistics, weighted ratios, and a one-sample T-test were used. RESULTS: Ninety-two nurse experts from seven countries and three continents participated in this study. Fifty-eight nurse experts (63%) were female, and 33 (36%) were male, with a mean age of 42.26 years and 19.22 years of working experience. The diagnosis label, definition, 4 out of 5 risk factors (RF), 6 out of 14 at-risk populations (ARPs), and 5 out of 9 associated conditions (ACs) were classified as major. One RF, eight ARP, and four ACs were considered minor. In addition, the experts validated 1 RF, 5 ARP, and 12 ACs from a previous literature study at least minor. CONCLUSIONS: The nursing diagnosis RPH (00254) could be confirmed by specialized experts. No RF, ARP, or AC of the current nursing diagnosis needed to be rejected, and the added diagnostic indicators increased the robustness of the diagnosis. IMPLICATIONS FOR NURSING PRACTICE: A precise concept of the nursing diagnosis RPH improves nurses' clinical reasoning and strengthens an individualized, evidence-based care plan.

Content validation of the nursing diagnosis "ineffective protection" in the context of adolescents with cancer.

OBJECTIVE: To analyze the relevance of a set of clinical elements to represent the content domain of the nursing diagnosis Ineffective Protection. DESIGN AND METHODS: This study employed content validation, using expert judgment to assess the appropriateness of clinical indicators, etiological factors, and conceptual and operational definitions, integrating the collective wisdom framework, the theory of predictive diversity, and the determination of rater skill level. RESULTS: From the middle range theory, 28 clinical indicators and 17 etiological factors were identified, which were rated by 34 raters. The analysis showed that the clinical indicators restlessness and insomnia and the etiological factors ambient temperature and humidity were not considered relevant for the nursing diagnosis of Ineffective Protection, because the median content validity index was lower than 0.9. CONCLUSIONS: Content validation verified that most of the components of the nursing diagnosis of Ineffective Protection were considered relevant by judges. PRACTICAL IMPLICATIONS: It is believed that the data obtained can help nurses to more easily evaluate the related factors and clinical indicators of Ineffective Protection presented by adolescents with cancer, which favors the process of diagnostic inference.

Nursing interventions for the proposed nursing diagnosis of puerperal fatigue: An integrative review.

INTRODUCTION: The postpartum period is considered a phase of many physiological and hormonal changes that affect the individual. Fatigue is something present and can influence the postpartum woman in a negative way. In this way, the nurse has an essential role, and the nursing process can be used to establish an efficient care plan. OBJECTIVE: To present the main nursing interventions and activities of the nursing diagnosis (ND) fatigue (00093) in individuals/people in the immediate postpartum period obtained through an integrative literature review and correlate with the proposed ND puerperal fatigue/excessive burden of fatigue in the postpartum period. METHODS: Integrative literature review, carried out in the databases Cochrane, Scopus and Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science (WoS), Virtual Health Library (VHL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL), following rigorous methodological standards. RESULTS: Six articles were included that identified the main nursing interventions related to the proposed ND puerperal fatigue. CONCLUSIONS: The integrative review highlighted the main nursing interventions and activities, and this study will be the basis for the next stages of the validation process for the ND puerperal fatigue/excessive fatigue in the postpartum period. IMPLICATIONS FOR NURSING PRACTICE: This work can help nurses in clinical practice establish an efficient care plan through the most accurate nursing interventions and thus improve the quality of nursing services.

INTRODUÇÃO: Considera­se o puerpério uma fase de muitas alterações fisiológicas e hormonais que acomete o indivíduo. A Fadiga é algo presente e que pode influenciar a puérpera de forma negativa. Dessa forma, o enfermeiro tem um papel imprescindível, e utiliza o Processo de Enfermagem para estabelecer um eficiente plano de cuidados. OBJETIVO: Apresentar as principais Intervenções e Atividades de enfermagem do Diagnóstico de Enfermagem Fadiga (00093) em indivíduos/pessoas no pós­parto imediato obtidos por meio de revisão integrativa da literatura e correlacionar com o proposto Diagnóstico de Enfermagem Fadiga Puerperal/Carga Excessiva de Fadiga no Pós­Parto Imediato. MÉTODOS: Revisão integrativa de literatura, realizada nas bases de dados, COCHRANE, SCOPUS e Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of science (WoS), Bilbioteca virtual de saúde (BVS) e Cumulative Index to Nursing and Allied Health Literature (CINAHL), seguindo padrões metodológicos rigorosos. RESULTADOS: Foram incluídos seis artigos que identificaram as principais intervenções de enfermagem relacionado ao proposto Diagnóstico de Enfermagem Fadiga Puerperal/ Carga Excessiva de Fadiga no Pós­Parto Imediato. CONCLUSÃO: A revisão integrativa evidenciou as principais intervenções e atividades de enfermagem e esse estudo será base para as próximas etapas do Processo de validação do Diagnóstico de Enfermagem Fadiga puerperal/Carga Excessiva de Fadiga no Pós­Parto Imediato.

Nursing diagnoses related to cardiovascular function in primary care: A scoping review: Diagnósticos de enfermagem relacionados a função cardiovascular na atenção primária: Scoping review.

OBJECTIVE: To map nursing diagnoses related to cardiovascular function reported in studies involving patients in primary care. METHOD: A scoping review follows JBI guidelines. Literature searches were conducted from March to May 2024. Studies included focused on nursing diagnoses for adults and older adult patients with cardiovascular conditions in primary care settings. Results were systematically presented in tables and narratively. FINDINGS: Among the 12 included studies, the most prevalent diagnosis was "noncompliance" (00079), removed from NANDA-I in 2017. Sixteen other diagnoses were identified, indicating a broader clinical profile of individuals with cardiovascular health issues in primary care. Most studies involved patients with hypertension in Brazil. CONCLUSIONS: Key nursing diagnoses for patients with cardiovascular conditions in primary care were identified. Ineffective health management emerged as a common characteristic among this population. IMPLICATIONS FOR NURSING PRACTICE: Identifying prevalent diagnoses allows nurses to reinforce their commitment to managing cardiovascular conditions, improve care plans, and generate practice indicators for services, thus enhancing the quality of care provided.

OBJETIVO: Mapear diagnósticos de enfermagem relacionados à função cardiovascular relatados em estudos envolvendo pacientes da atenção primária. MÉTODO: Trata­se de uma revisão de escopo, seguindo as diretrizes do JBI. As pesquisas bibliográficas foram realizadas de março a maio de 2024. Foram incluídos estudos sobre diagnósticos de enfermagem para pacientes adultos e idosos, com doenças cardiovasculares, no cenário da atenção primária. Os resultados foram apresentados sistematicamente em tabelas e de forma narrativa. RESULTADOS: Entre os 13 estudos incluídos, o diagnóstico mais prevalente foi "falta de adesão" (00079), retirado da NANDA­I em 2017. Foram identificados outros 16 diagnósticos, indicando um perfil clínico mais amplo de indivíduos com problemas de saúde cardiovascular em cuidados primários. A maioria dos estudos envolveu pacientes com hipertensão no Brasil. CONCLUSÕES: Foram identificados os principais diagnósticos de enfermagem para pacientes com doenças cardiovasculares na atenção primária. A gestão insuficiente da saúde emergiu como uma característica comum entre esta população. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A identificação de diagnósticos prevalentes permite aos enfermeiros reforçarem o seu compromisso com a gestão das condições cardiovasculares, melhorar os planos de cuidados e gerar indicadores de prática para os serviços, melhorando assim a qualidade dos cuidados prestados.

Accuracy of the defining characteristics of respiratory nursing diagnoses in patients with COVID-19.

OBJECTIVE: To analyze the accuracy of the defining characteristics of four respiratory nursing diagnoses (ND) in patients with COVID-19 and on oxygen therapy. METHODS: This is a cross-sectional study conducted in four Brazilian public hospitals in two regions of the country. A total of 474 patients with COVID-19 receiving oxygen therapy were assessed. Latent-adjusted class analysis with random effects was used to establish the sensitivity (Se) and specificity (Sp) of the defining characteristics evaluated for each ND. RESULTS: Among the ND that constituted the study (impaired spontaneous ventilatory, impaired gas exchange, ineffective airway clearance, and dysfunctional ventilatory weaning response), the following defining characteristics had the highest simultaneous Se and Sp (>0.8): decrease in tidal volume, confusion, irritability, dyspnea, decreased breath sounds, orthopnea, impaired ability to cooperate and respond to coaching, and decrease in the level of consciousness. CONCLUSIONS: Recognizing the clinical signs that predict respiratory ND in patients affected by COVID-19 can contribute to the nurse's accurate diagnostic inference and designate the appropriate nursing interventions to achieve the desired results and avoid complications.

OBJETIVO: Analisar a acurácia das características definidoras de quatro Diagnósticos de Enfermagem (DE) respiratórios em pacientes com COVID­19 e em uso de oxigenoterapia. MÉTODOS: Estudo transversal, realizado em quatro hospitais públicos brasileiros de duas regiões do país. Foram avaliados 474 pacientes diagnosticados com COVID­19 e em uso de oxigenoterapia. A análise de classe latente ajustada com efeitos randômicos foi utilizada para estabelecer a sensibilidade (Se) e especificidade (Sp) das características definidoras avaliadas para cada DE. RESULTADOS: As características definidoras volume corrente diminuído, confusão, irritabilidade, dispneia, sons respiratórios diminuídos, ortopneia, capacidade prejudicada para cooperar e responder orientações, e nível de consciência diminuído foram as que obtiveram maior sensibilidade e especificidade simultaneamente (> 0.8) dentre os diagnósticos de enfermagem compuseram o estudo: Ventilação espontânea prejudicada, Resposta disfuncional ao desmame, Desobstrução ineficaz das vias aéreas e Troca de gases prejudicada. CONCLUSÕES: Conhecer os sinais clínicos preditores dos diagnósticos de enfermagem respiratórios em pacientes acometidos por COVID­19 pode contribuir para a inferência diagnóstica acurada do enfermeiro e designar as intervenções de enfermagem apropriadas para atingir os resultados desejados e evitar complicações.

Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol.

Aims: To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain. Design: Multicentric, mixed method concurrent study. Methods: This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022). Discussion: The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic. Trial Registration: Identifier: NCT05249868 [ClinicalTrials.gov].

Development of a Nursing Diagnosis/Record Generative AI System Based on Virtual Patient Data.

This study investigates how to reduce nurses' repetitive electronic nursing record tasks. We applied generative AI by learning nursing record data practiced with virtual patient data. We aim to evaluate generative AI's usefulness, usability, and availability when applied to nursing record creation tasks. The nursing record data collected through the electronic nursing record system for nursing students without privacy issues is in the form of NANDA, FocusDAR, SOAPIE, and narrative records. We trained 50,000 nursing record data and upgraded the performance through generative AI and fine-tuning. A separate API was used to connect with the practice electronic nursing record system, and 40 experienced nurses from a university hospital conducted tests. The electronic nursing record, through generative AI, is expected to contribute to easing the workload of nurses.

Making room for occupational health nursing in Nanda­I: "Impaired foot health" as a diagnosis.

OBJECTIVE: Discuss the label "impaired foot health" to be considered a problem-focused nursing diagnosis according to the taxonomy of NANDA-I. METHODS: Discussion article based on literature reviews and observational studies based on the authors' PhD ongoing research about foot health among nursing students and professionals. FINDINGS: Attending to the definition of nursing diagnosis and the scope of nursing practice internationally, several human responses and contexts should be considered, opening new opportunities for NANDA-I completeness. CONCLUSIONS: A new nursing diagnosis has been disclosed, opening new dimensions to the NANDA-I taxonomy. IMPLICATIONS FOR NURSING: This nursing diagnosis represents an opening door for the taxonomy, particularly for occupational health nursing in an international context.

OBJETIVO: Descrever de que forma a "saúde do pé comprometida" pode ser considerado um diagnóstico de enfermagem centrado no problema a incluir na taxonomia da NANDA­I. MÉTODOS: Artigo de discussão baseado em revisões da literatura e estudos observacionais incluídos no estudo de doutoramento em curso dos autores sobre a saúde do pé em estudantes de enfermagem e enfermeiros. RESULTADOS: Atendendo à definição de diagnósticos de enfermagem e no âmbito da prática de enfermagem a nível internacional, várias respostas humanas e contextos profissionais devem ser considerados, abrindo novas oportunidades para a completude da NANDA­I. CONCLUSÕES: Um novo diagnóstico de enfermagem foi revelado, descobrindo novas dimensões para a taxonomia da NANDA­I. IMPLICAÇÕES PARA A ENFERMAGEM: Este diagnóstico de enfermagem representa uma oportunidade para a taxonomia, nomeadamente para a enfermagem de saúde ocupacional em contexto internacional.

Clinical validation of "spiritual distress (00066)" in parents of children with chronic diseases.

PURPOSE: This study aimed to determine the clinical validation of the nursing diagnosis (ND) of "spiritual distress (00066)" and the sensitivity, specificity, likelihood ratio, and predictive value in parents of children with chronic diseases. METHODS: This cross-sectional study was conducted using the clinical diagnostic validity method proposed by Fehring. The data were collected through structured interviews and using a researcher-made list that included 5 parts of demographic information, parents' opinions about spiritual distress, the researcher's diagnosis, 74 defining characteristics (DCs) of the ND of spiritual distress, and the Spiritual Well-being Questionnaire. Data were analyzed using descriptive statistics as well as sensitivity, specificity, likelihood ratio, and predictive value. FINDINGS: The prevalence of diagnosis was 70% in a sample of 120 parents. Out of the 74 DCs, 39 criteria were validated. Questioning meaning of illness and suffering had the highest sensitivity (98.8%), the highest negative predictive value (88.88%), and the lowest negative likelihood ratio (0.05%). Expressing the lack of meaning in life demonstrated the highest specificity (97.22%), the highest positive predictive value (98.33%), and the highest positive likelihood ratio (25.26%). CONCLUSIONS: Parents who search for meaning of illness and suffering related to a lack of meaning in life are in spiritual distress. The ND was validated. IMPLICATIONS FOR NURSING PRACTICE: These findings can empower clinical nurses to confidently assess and identify patients experiencing spiritual distress, bridging the gaps caused by the absence of standardized tools for assessing spiritual distress in the inpatient setting.

Clinical validation of the ineffective social support network nursing diagnosis in violence-victimized women.

PURPOSE: To verify clinical validity evidence for the ineffective social support network nursing diagnosis. METHOD: A quantitative, descriptive, cross-sectional study was performed with 98 violence-victimized women treated in two reference centers for violence in the city of Recife, Pernambuco, Brazil. The women were interviewed from August 2021 to June 2022. FINDINGS: The clinical indicators that best predicted the nursing diagnosis were as follows: Frustration with unmet support expectations, negative social interaction, perceived neglect of support demands, feeling of abandonment, low reciprocity, and encouragement of negative behaviors. Etiological factors that showed greater association were excessive demand for support, limited social network, social isolation, the fragility of institutional service networked organizations, and inadequate appreciation of available social support. CONCLUSIONS: The clinical validity evidence for the ineffective social support network nursing diagnosis has been verified. Thus, the validated clinical indicators and etiological factors can accurately diagnose and predict the emergence of this phenomenon in violence-victimized women. IMPLICATIONS FOR NURSING PRACTICE: The results contribute to advancing scientific knowledge in nursing teaching, research, and practice and support the nursing process in violence-victimized women.

OBJETIVO: Verificar evidências de validade clínica para o diagnóstico de enfermagem Rede de Apoio Social Ineficaz. MÉTODO: Estudo quantitativo, descritivo e transversal realizado com 98 mulheres vítimas de violência atendidas em dois centros de referência em violência na cidade do Recife, Pernambuco, Brasil. As mulheres foram entrevistadas no período de agosto de 2021 a junho de 2022. RESULTADOS: Os indicadores clínicos que melhor predisseram o diagnóstico de enfermagem foram: Frustração com Expectativas de Apoio Não Atendidas, Interação Social Negativa, Negligência Percebida nas Demandas de Apoio, Sentimento de Abandono, Baixa Reciprocidade e Incentivo a Comportamentos Negativos. Os fatores etiológicos que apresentaram maior associação foram Demanda Excessiva de Apoio, Rede Social Limitada, Isolamento Social, Fragilidade das Organizações em Rede de Serviços Institucionais e Valorização Inadequada do Apoio Social Disponível. CONCLUSÕES: Foram verificadas evidências de validade clínica para o diagnóstico de enfermagem Rede de Apoio Social Ineficaz. Assim, os indicadores clínicos e fatores etiológicos validados têm a capacidade de diagnosticar e prever com precisão o surgimento deste fenômeno em mulheres vítimas de violência. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A validação clínica do diagnóstico fundamenta as intervenções de enfermagem direcionadas às mulheres vítimas de violência e à sua rede de apoio social. PALAVRAS­CHAVE: Apoio social; Educação saudável; diagnóstico de enfermagem; rede social; violência contra as mulheres.

Discussing the midwifery scope of practice within the NANDA-I taxonomy.

PURPOSE: To discuss the midwifery scope of practice within the NANDA-I taxonomy. METHODS: Review of the NANDA-I taxonomy followed by critical analysis of the nursing diagnoses (NDs) within the scope of midwifery practice. Search terms were defined. Two authors independently analyzed all diagnoses, and another author validated the results. FINDINGS: Of the 267 NDs in the NANDA-I taxonomy, 39 (14.6%) perceived a relationship with midwifery's scope of practice, and among these, 15 (5.6%) guaranteed greater specificity and accuracy for clinical reasoning. CONCLUSIONS: The suitability of NDs for the broad spectrum of the midwifery scope of practice may need to be completed. Women's responses to life events and health conditions are simultaneously complex and specific, and many NDs in the NANDA-I terminology may be far from fully identified and developed to represent these responses. IMPLICATIONS FOR NURSING PRACTICE: Improvements in NANDA-I diagnosis would contribute to advanced terminology and increased specificity and accuracy of the diagnostic process. This is important in achieving appropriate outcomes and safe and effective interventions for which the nurses and nurse-midwives are accountable. Many NDs would not necessarily be used in any other context since they are specific to midwifery; however, it would help to develop a NANDA-I taxonomy that is more inclusive and comprehensive internationally.

OBJETIVO: Discutir o âmbito da prática de atenção materna dentro da taxonomia da NANDA­I. MÉTODOS: Revisão da taxonomia da NANDA­I com análise crítica dos diagnósticos de enfermagem, no âmbito da prática de atenção materna. Os termos de pesquisa foram definidos. Dois autores analisaram, independentemente, todos os diagnósticos e um outro autor validou os resultados. RESULTADOS: Dos 267 diagnósticos de enfermagem da taxonomia NANDA­I, em 39 (14,6%) percebe­se relação com o âmbito da prática de atenção materna. Além disso, destes 38 diagnósticos incluídos, 15 (5,6%) garantem maior especificidade e acurácia para o raciocínio clínico. CONCLUSÕES: A adequação dos diagnósticos de enfermagem ao amplo espectro da prática de atenção materna pode precisar ser completada. As respostas das mulheres aos acontecimentos de vida e às condições de saúde são, simultaneamente, complexas e específicas e muitos diagnósticos de enfermagem na terminologia da NANDA­I podem não estar totalmente identificados e desenvolvidos para representar essas respostas. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Melhorias nos diagnósticos da NANDA­I contribuiriam para uma terminologia avançada e para o aumento da especificidade e precisão do processo de diagnóstico. Isto é importante para a obtenção de resultados apropriados e intervenções seguras e eficazes, pelas quais os enfermeiros de atenção à saúde materna são responsáveis. Muitos diagnósticos de enfermagem não seriam necessariamente usados em qualquer outro contexto, uma vez que são específicos da atenção materna; no entanto, ajudaria a desenvolver uma taxonomia NANDA­I mais inclusiva e abrangente, a nível internacional.

Ineffective coping (00069): A Walker and Avant conceptual analysis.

PURPOSE: To analyze the diagnostic concept of "ineffective coping" (00069) proposed by NANDA-I, using Walker and Avant's framework. DATA SOURCES: The theoretical framework of Walker and Avant was used for the concept analysis. A search was performed in the Virtual Health Library portal using the keywords "ineffective coping" and "enfrentamento ineficaz." DATA SYNTHESIS: According to the literature, ineffective coping is defined as an adoption of inadequate psychosocial and behavioral strategies in response to a set of contextual stressors that negatively affect well-being and lifestyle. CONCLUSIONS: The concept created for ineffective coping has the potential to address the psychosocial elements associated with life experiences in the face of coping mechanisms. IMPLICATIONS FOR NURSING PRACTICE: This analysis may contribute to the improvement of nursing care for patients experiencing difficult situations in their lives, as well as the challenges of nursing interventions that promote positive adaptation.

OBJETIVO: Analisar o conceito diagnóstico de "Enfrentamento Ineficaz" proposto pela NANDA­Internacional, por meio do referencial de Walker e Avant. FONTE DOS DADOS: O referencial teórico de Walker e Avant foi adotado para a análise de conceito. Assim, realizou­se busca no portal da Biblioteca Virtual em Saúde, por meio das palavras­chaves "ineffective coping" e "enfrentamento ineficaz." SÍNTESE DOS DADOS: Pela literatura, o enfrentamento ineficaz é definido como uma adoção de estratégias inadequadas comportamentais e psicossociais em resposta a uma configuração de estressores contextuais que negativamente afetam o bem estar e o estilo de vida. CONCLUSÃO: O conceito criado para o enfrentamento ineficaz possui potencial em ajustar os elementos psicossociais interligados às experiências de vida perante o mecanismo de enfrentamento. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Tal análise pode contribuir na melhoria dos cuidados de enfermagem a pacientes que estejam experienciando situações limites em suas vidas, assim como os desafios para intervenções de enfermagem que favoreçam a adaptação positiva.

Clinical validation of the nursing diagnosis "Fall risk in adults (00303)" in elderly people in the community-dwelling.

PURPOSE: To identify the risk factors for the nursing diagnosis of fall risk in adults (00303) in elderly people in the community-dwelling. METHOD: This is a methodological study, with a quantitative approach, carried out with elderly people living in the city of Ribeirão Preto, SP, Brazil, from February to December 2018. For data collection, the demographic profile, Mini-Mental State Examination, diseases self-reported, functional independence measure, Lawton and Brody scale, geriatric depression scale, and self-perception of gait instruments were used. Tests of accuracy and association of risk factors with p ≤ 0.05 were performed. FINDINGS: A total of 262 elderly people, aged over 80 years (55.7%), 71% of which were female and 42.7% were widowed, were included in the sample. A total of 82.1% had vascular diseases, 72.1% had diabetes, and 20.6% had depression. The predominant risk factors were difficulty performing instrumental activities of daily living (58.8%), cognitive dysfunction (43.5%), and depressive symptoms (26.3%). Difficulty performing instrumental activities of daily living had a sensitivity greater than 60%. The positive and negative predictive values were mostly greater than 50%. In the regression analysis, it was found that the elderly have a higher risk of suffering a fall if they present anxiety (p = 0.05), impaired physical mobility (p = 0.02), and difficulty to perform instrumental activities of daily living as risk factors (p = 0.03). CONCLUSION: It was possible to identify the presence of risk factors for the diagnosis fall risk in adults (00303) in the clinical context of the elderly in home settings and contribute to the clinical validation of the taxonomy, increase the evidence and importance of the diagnosis, and generate new knowledge for gerontological nursing. IMPLICATIONS FOR NURSING PRACTICE: To help nurses identify risk factors that lead elderly people to suffer falls at home and to implement preventive actions in their community with the support of their families.

OBJETIVO: Identificar os fatores de risco para o diagnóstico de enfermagem Risco de Quedas em adultos (00303) em idosos do domicílio. MÉTODO: Trata­se de um estudo metodológico, com abordagem quantitativa, realizado com idosos residentes na cidade de Ribeirão Preto, SP, Brasil, no período de fevereiro a dezembro de 2018. Para coleta de dados foram utilizados instrumentos de perfil sociodemográfico, Mini exame do Estado Mental, doenças autorreferidas, Medida de Independência Funcional, Escala de Lawton e Brody, Escala de Depressão Geriátrica e autopercepção da marcha. Foram realizados testes de acurácia e associação de fatores de risco com p ≤ 0,05. RESULTADOS: Participaram 262 idosos, com idade superior a 80 anos (55,7%), sendo 71% do sexo feminino e 42,7% viúvos. Um total de 82,1% tinha doenças vasculares, 72,1% tinham diabetes e 20,6% tinham depressão. Os fatores de risco predominantes foram dificuldade para realizar atividades instrumentais de vida diária (58,8%), déficit cognitivo (43,5%) e sintomas depressivos (26,3%). A dificuldade para realizar atividades instrumentais da vida diária apresentou sensibilidade superior a 60%. Os valores preditivos positivos e negativos foram em sua maioria superiores a 50%. Na análise de regressão constatou­se que os idosos apresentam maior risco de sofrer queda se apresentarem Ansiedade (p = 0,05), Mobilidade física prejudicada (p = 0,02) e Dificuldade para realizar atividades instrumentais de vida diária (p = 0,03). CONCLUSÃO: Foi possível identificar a presença de fatores de risco para o diagnóstico Risco de queda em adultos (00303) no contexto clínico do idoso em ambiente domiciliar e contribuir para a validação clínica da taxonomia, aumentar a evidência e a importância do diagnóstico e gerar novos conhecimentos para a enfermagem gerontológica. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Ajudar os enfermeiros a identificar os fatores de risco que levam os idosos a sofrer quedas no domicílio e a implementar ações preventivas na sua comunidade com o apoio dos seus familiares.

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.

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.

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.

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.

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.

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.