The Contribution of the Rasch Model to the Clinical Validation of Nursing Diagnoses: Integrative Literature Review.

PURPOSE: To analyze the knowledge related to the use of the Rasch model in validation of nursing diagnoses. METHODS: Integrative literature review with search in LILACS, PUBMED, CINAHL, and SCOPUS. FINDINGS: Five studies comprised the sample, which analyzed unidimensionality, local independence, item calibration, item reliability, separation of items and people, and differential item functioning for analyzing nursing diagnoses. CONCLUSIONS: The Rasch model seems to be a useful method to validate nursing diagnoses and probably also for the validation of nursing outcomes in the Nursing Outcomes Classification. The use of this model is promising, considering the advantages that it can be used in studies with several methodological designs. IMPLICATIONS FOR NURSING: Methods that are able to provide more robust evidence of nursing diagnosis validity are needed to support highly accurate diagnostic findings in clinical practice.

Assessing sensitivity and specificity of the Manchester Triage System in the evaluation of acute coronary syndrome in adult patients in emergency care: a systematic review.

BACKGROUND: Triage is the first assessment and sorting process used to prioritize patients arriving in the emergency department (ED). As a triage tool, the Manchester Triage System (MTS) must have a high sensitivity to minimize the occurrence of under-triage, but must not compromise specificity to avoid the occurrence of overtriage. Sensitivity and specificity of the MTS can be calculated using the frequency of appropriately assigned clinical priority levels for patients presenting to the ED. However, although there are well established criteria for the prioritization of patients with suspected acute coronary syndrome (ACS), several studies have reported difficulties when evaluating patients with this condition. OBJECTIVE: The objective of this review was to synthesize the best available evidence on assessing the sensitivity and specificity of the MTS for screening high-level priority adult patients presenting to the ED with ACS. METHOD: The current review considered studies that evaluated the use of the MTS in the risk classification of adult patients in the ED. In this review, studies that investigated the priority level, as established by the MTS to screen patients under suspicion of ACS or the sensitivity and specificity of the MTS, for screening patients before the medical diagnosis of ACS were included. This review included both experimental and epidemiological study designs. RESULTS: The results were presented in a narrative synthesis. Six studies were appraised by the independent reviewers. All appraised studies enrolled a consecutive or random sample of patients and presented an overall moderate methodological quality, and all of them were included in this review. A total of 54,176 participants were included in the six studies. All studies were retrospective. Studies included in this review varied in content and data reporting. Only two studies reported sensitivity and specificity values or all the necessary data to calculate sensitivity and specificity. The remaining four studies presented either a sensitivity analysis or the number of true positives and false negatives. However, these four studies were conducted considering only data from patients diagnosed with ACS. Sensitivity values were relatively uniform among the studies: 0.70-0.80. A specificity of 0.59 was reported in the study including only patients with non-traumatic chest pain. On the other hand, in the study that included patients with any complaint, the specificity of MTS to screen patients with ACS was 0.97. CONCLUSION: The current review demonstrates that the MTS has a moderate sensitivity to evaluate patients with ACS. This may compromise time to treatment in the ED, an important variable in the prognosis of ACS. Atypical presentation of ACS, or high specificity, may also explain the moderate sensitivity demonstrated in this review. However, because of minimal data, it is not possible to confirm this hypothesis. It is difficult to determine the acceptable level of sensitivity or specificity to ensure that a certain triage system is safe.

Caregiver role strain: bi-national study of content validation / Cansancio del rol de cuidador: estudio binacional de validación de contenido / Tensão do papel de cuidador: estudo binacional de validação de conteúdo

Objective.To estimate content validity of the diagnosis Caregiver Role Strain. Methods. Content validation of the defining characteristics according to Fehring's model was undertaken by 6 Colombian nurses and 9 Brazilian counterparts. The relevance of each defining characteristic for the diagnosis was assessed using 5-point Likert type scale. The Mann-Whitney test was used to estimate differences in assessing the relevance of defining characteristics between Brazilian and Colombian nurses. Results. From 36 defining characteristics, 22 were identified as major, 13 as secondary and one as irrelevant (rash). The content validity index(sum of weighted averages divided by the total number of defining characteristics) was 0.79, considered adequate. Conclusion. Most of the defining characteristics were considered relevant to the nursing diagnosis Caregiver Role Strain. These findings reflect consensus among specialists from two different countries in relation to the relevance of the defining characteristics for this diagnosis.

Objetivo.Estimar la validez de contenido del diagnóstico Cansancio del rol de cuidador. Métodos. Validación de contenido de las características definitorias por seis enfermeras colombianas y nueve enfermeras brasileñas, de acuerdo con el modelo de Fehring's. La relevancia de cada característica definitoria para el diagnóstico se evaluó utilizando una escala Likert de cinco puntos. Resultados. De las 36 características definitorias, 22 se identificaron como principales; 13, secundarias y una como irrelevante. No hubo diferencia entre las puntuaciones atribuidas por las enfermeras brasileñas y colombianas. El puntaje total de validez de contenido del diagnóstico (sumatoria de los promedios ponderados, medias ponderadas divididas por el número total de características definitorias) fue adecuado (0.79). Conclusión. La mayoría de las características definitorias fueron consideradas relevantes para el diagnóstico Cansancio del rol de cuidador. Estos hallazgos reflejan un consenso entre expertos de dos países diferentes con relación a la relevancia de las características definitorias para el diagnóstico.

Objetivo.Estimar a validade de conteúdo do diagnóstico de enfermagem Tensão do papel de cuidador. Métodos. Validação de conteúdo das caraterísticas definidoras por 9 enfermeiros brasileiros e 6 enfermeiros colombianos, segundo o modelo proposto por Fehring. A pertinência de cada caraterística definidora ao diagnóstico foi avaliada por meio de escala tipo Likert de 5 pontos. Resultados. Das 36 caraterísticas definidoras 22 foram identificadas como principais, 13 como secundárias e uma como irrelevante. A pontuação total de validez de conteúdo do diagnóstico (somatória das médias ponderados dividida pelo número total de características definitivas) foi adequado (0.79). Não houve diferenças entre as pontuações atribuídas pelos enfermeiros brasileiros e colombianos. Conclusão. A maioria das características definidoras foram consideradas pertinentes para Tensão do papel de cuidador. Os detectados refletem consenso entre expertos de dois países em relação à pertinência das características definidoras ao diagnóstico.

Caregiver role strain: bi-national study of content validation.

OBJECTIVE: To estimate content validity of the diagnosis Caregiver Role Strain. METHODS: Content validation of the defining characteristics according to Fehring's model was undertaken by 6 Colombian nurses and 9 Brazilian counterparts. The relevance of each defining characteristic for the diagnosis was assessed using 5-point Likert type scale. The Mann-Whitney test was used to estimate differences in assessing the relevance of defining characteristics between Brazilian and Colombian nurses. RESULTS: From 36 defining characteristics, 22 were identified as major, 13 as secondary and one as irrelevant (rash). The content validity index(sum of weighted averages divided by the total number of defining characteristics) was 0.79, considered adequate. CONCLUSION: Most of the defining characteristics were considered relevant to the nursing diagnosis Caregiver Role Strain. These findings reflect consensus among specialists from two different countries in relation to the relevance of the defining characteristics for this diagnosis.

Usability Testing of PROCEnf-USP: A Clinical Decision Support System.

Decision support systems (DSSs) are recognized as important tools, capable of processing high volumes of data and increasing productivity. The usability of these tools affects their effectiveness. By evaluating the interactions between registered nurses (RNs) and the DSSs, this study explores how they impact RN decision-making. This study analyzed 24 months (2011-2012) of data collected in Brazil in two units of a large, public, urban hospital in São Paulo that uses a nurse documentation system with an embedded DSS based on NANDA-I. Using mixed effects logistic regression, this study analyzed the agreement between RNs and a DSS when selecting nursing diagnoses. Results suggest that the agreement is mediated by characteristics of the RNs (education and experience) as well as units and year of encounter. Surprisingly, disagreement between RN and DSS when selecting defining characteristics (DC) had positive effects on the odds of agreement on diagnoses. Our results suggest that DSSs support nurses' clinical decision making, but the nurse's clinical judgment is the mediating factor. More research is necessary.

PROCenf evaluation: Are the assessments triggering the correct NANDA-I diagnoses?

PROCEnf-USP is a decision support system that offers staff nurses at the University Hospital in Sao Paulo, Brazil a set of questionnaires to guide patient assessment. Using the answers, the system computes probabilities for nursing diagnoses based on NANDA-I. This study aims to evaluate PROCenf in terms of its reliability (Does it consistently gives the right diagnose?) and its validity in Brazil (Does NANDA-I terminology represent the healthcare experience of a Brazilian population).

Attributing fuzzy values to nursing diagnoses and their elements: the specialists' opinion.

PURPOSE: To test the viability of to use specialists' opinions to establish degrees of membership between nursing diagnoses and its elements (defining characteristics or risk factors), based on the concepts of fuzzy sets theory. This strategy may feasibly mapping the specialist's knowledge on the diagnostic task. METHODS: Specialists were invited to reflect on the relationship between diagnoses and elements using linguistic variables, with a numerical representation. FINDINGS: We generated four matrices of 28 diagnoses and 62 elements. Out of 905 possibilities, we identified 286 relationships, represented in graphs. CONCLUSIONS: The strategy was able to identify degrees of membership between nursing diagnoses and elements. IMPLICATIONS: It seems that this method, if expanded, would contribute to refining and mapping the NANDA-I terminology.

Evaluation of pain and accuracy diagnostic in hospitalized children.

PURPOSE: Acute pain occurs in over 50% of hospitalized children. The accuracy of this diagnosis has been underexplored in the literature, as has the role of training to implement pain assessment. This study analyzed the accuracy of acute pain diagnoses after the implementation of a systematic evaluation of pain (study intervention). METHOD: The sample was divided into: pre- and postintervention. The Nursing Diagnosis Accuracy Scale, which scores accuracy as null, low, moderate, or high, was used. RESULTS: In the postimplementation, acute pain was diagnosed more often. However, accuracy only improved in the moderate category. CONCLUSION: Diagnosis of acute pain increased in the postimplementation period, but accuracy did not. IMPLICATIONS: The development of strategies for improvement of diagnostic accuracy is warranted.

Conceptualization of an electronic system for documentation of nursing diagnosis, outcomes, and intervention.

Electronic nursing documentation constitutes technical, scientific, legal, and ethical documents. The objective of this study was to develop an electronic nursing documentation system. The system was developed in four phases (conceptualization, detailing, prototype building, implementation), and the knowledge base was based on domains and classes according to the NANDA-I, NIC, and NOC unified framework. The result is an electronic system (PROCEnf--USP--Nursing Process Electronic Documentation System of the University of São Paulo) which allows documenting nursing process generating reports of nursing process, besides supporting decisions on nursing diagnosis, expected outcomes, and interventions. Integration of different fields of knowledge, as well as the institutional feature of valuing continuous theoretical and practical improvement of nursing process were factors of success of this technological project.

Clinical reasoning and critical thinking.

This study identifies and analyzes nursing literature on clinical reasoning and critical thinking. A bibliographical search was performed in LILACS, SCIELO, PUBMED and CINAHL databases, followed by selection of abstracts and the reading of full texts. Through the review we verified that clinical reasoning develops from scientific and professional knowledge, is permeated by ethical decisions and nurses values and also that there are different personal and institutional strategies that might improve the critical thinking and clinical reasoning of nurses. Further research and evaluation of educational programs on clinical reasoning that integrate psychosocial responses to physiological responses of people cared by nurses is needed.

Characteristics of fatigue in heart failure patients: a literature review.

This is a literature review report to describe characteristics (frequency, intensity and correlates) of fatigue in cases of heart failure. MedLine and LILACS were the examined databases. Out of 89 articles identified, 27 were selected for data extraction. Fatigue frequency ranged from 69% to 88% and fatigue intensities are incomparable due to differences in measurement scales. Quality of life, illness progression, physical activity, social and demographic variables, comorbidity, treatment and who assessed the fatigue were variables studied in relation to fatigue. The diversity of fatigue assessment methods causes difficulties to integrate results on fatigue frequency, characteristics and related factors. No study was found on fatigue characteristics in samples of Brazilian heart failure patients.

Nurses' perception of power regarding their clinical role.

This article reports on a study on nurses' perception of power regarding their clinical role before and after implementation of a nursing diagnosis classification. Sixty clinical nurses (average age=37.2+/-7.0 years) from a Brazilian teaching hospital answered the Power as Knowing Participation in Change Tool (PKPCT) before and after the implementation of a diagnosis classification. PKPCT has four domains and provides total and partial scores. Reliability coefficients ranged from 0.88 to 0.98. Total scores were not statistically different between assessments (p=0.21), although scores in the 'Involvement in Creating Change' domain were higher in the second assessment (p=0.04). Further studies providing sound evidence regarding the impact of nursing classification systems on nurses' power perception are needed to guide decisions on teaching and clinical practice.