Evidence of content validity of the nursing outcome "sexual functioning" from the nursing outcome classification.

PURPOSE: To evaluate the content validity evidence of the nursing outcome "sexual functioning" from the Nursing Outcomes Classification (NOC). METHODS: A multi-method study, including a methodological study analyzing the content validity evidence of the NOC outcome and sexual functioning, and a quantitative, descriptive, cross-sectional study. In the first phase, a literature review was conducted to map and identify clinical indicators associated with sexual functioning to construct the conceptual (CD) and operational definitions (ODs) of each outcome indicator. In the second phase, experts assessed the CD and OD for clarity, theoretical relevance, and theoretical pertinence. The critical validity ratio (CVR) was calculated for each indicator. In the third phase, a pilot test of sexual functioning measurement was conducted with 33 patients hospitalized for coronary artery disease. Internal consistency was calculated through Cronbach's alpha. RESULTS: The CD and OD were constructed based on 120 articles and analyzed by 13 experts; four rounds were required to achieve the critical CVR in each phase. In the pilot test, the nursing outcome achieved a Cronbach's alpha of 0.95, and the mean assessment time was 26 min. Indicators with the highest mean scores were related to knowledge of personal needs and capabilities and comfort with one's own body. CONCLUSION: The CD and OD developed for the NOC outcome, sexual functioning, had adequate evidence of content validity. The outcome content has high internal consistency. Further studies on the validity of the nursing outcome should be conducted to increase its validity. IMPLICATIONS FOR PRACTICE: The nursing outcome, sexual functioning, can be a tool used by nurses to evaluate the effect of nursing education and interventions on sexual functioning in the adult population.

PURPOSE: Desenvolver e avaliar as evidências de validade de conteúdo das definições conceituais e operacionais dos indicadores do resultado de Enfermagem "Funcionamento Sexual" da Classificação dos Resultados de Enfermagem (NOC). METHODS: Estudo metodológico dividido em três fases. Na primeira fase foi realizada uma revisão de literatura para mapear e identificar os indicadores clínicos associados ao funcionamento sexual para a construção das definições conceituais (DC) e operacionais (DO) de cada indicador do resultado de enfermagem em estudo. Na segunda fase foi realizada a análise das evidências de validade de conteúdo das DC e DO dos indicadores por meio da avaliação pelos especialistas. Na terceira fase foi realizada um pré­teste do resultado de enfermagem em 33 pacientes hospitalizados por doença arterial coronariana. RESULTS: Foram selecionados 120 artigos que serviram de base para a construção das definições conceituais e operacionais analisadas por 13 especialistas, necessário quatro rodadas para alcançar o coeficiente de validade de conteúdo crítico estabelecido para o número de juízes respondentes. pré­testeo resultado de enfermagem estudado um alfa de Cronbach de 0,95 e o tempo médio de aplicação foi de 26 minutos. Os indicadores com maiores médias estavam relacionados ao conhecimento das necessidades e capacidade pessoais e conforto com o próprio corpo. CONCLUSION: As DC e DO dos indicadores do resultado "Funcionamento Sexual" da NOC desenvolvidas apresentaram adequadas evidências de validade de conteúdo. O pré­teste o apresentou elevado nível de consistência interna. Outros estudos de evidências de validade do resultado estudado devem ser realizados visando o aumento no nível de validade do resultado. IMPLICATION FOR PRACTICE: O resultado estudado pode ser uma ferramenta utilizada pelo enfermeiro para avaliação do funcionamento sexual na população adulta visando a individualização das orientações e intervenções de enfermagem.

Development and content validity of educational videos on self-management of fluid restriction and thirst for individuals with heart failure.

OBJECTIVE: To create and evaluate the content validity of educational videos on self-management of fluid restriction and thirst for individuals with heart failure (HF). METHOD: A psychometric study was conducted in three stages: (1) an integrative literature review to identify strategies for self-management of fluid restriction and thirst by individuals with HF; (2) creation of animated videos about strategies for self-management of fluid restriction and thirst; and (3) analysis of the content validity of the educational videos by 11 experts. For each criterion, the content validity ratio (CVR) was calculated; it was considered adequate when <0.636. Suggestions were evaluated by the researchers, and the videos were modified. RESULTS: Ten scripts and videos were created, averaging 30 s each. The videos' contents were based on 11 studies retrieved from the review and one specialized website. The videos were evaluated by experts, and adjustments were made when CVR < 0.636 and when allowed by the video production platform. CONCLUSIONS: Educational videos were developed and have satisfactory content validity evidence according to expert opinions. IMPLICATIONS FOR NURSING PRACTICE: These videos are expected to be used as educational strategies in clinical practice to prevent episodes of decompensation due to excessive fluid volume.

Influencing the language of nursing: an interview with T. Heather Herdman and Sue Moorhead. Interview by Jeffrey M. Adams.

This department highlights nursing leaders who have demonstrated a commitment to leading change. This interview profiles the experiences and insights of nursing language standardization leaders T. Heather Herdman, PhD, RN, FNI, the CEO/executive director of NANDA-I, and Sue Moorhead, PhD, RN, FNI, the director of the Center for Nursing Classification and Clinical Effectiveness and associate professor at the University of Iowa, College of Nursing.

Validation of Nursing Outcomes Related to Breastfeeding Establishment.

PURPOSE: To clinically validate indicators of the nursing outcomes "Breastfeeding establishment: Infant (1000)" and "Breastfeeding establishment: maternal (1001)", and their conceptual and operational definitions in infants admitted to a neonatal unit and their mothers. METHOD: This study utilized several methods in a stepwise approach including an integrative review of the literature, content validation, and clinical validation. The content validity index was performed by eight experts, who evaluated revised content of the studied nursing outcomes. In the clinical validation, 61 mother-infant dyads were evaluated by two pairs of nurses: one pair used an instrument with developed definitions, whereas the other used an instrument without definitions. The evaluations were compared using Fleiss' kappa and weighted kappa. RESULTS: The agreement between all evaluators was considered excellent for almost all nursing outcome indicators related to the mothers. The pair of evaluators using the definitions had an agreement greater than 0.80 for most indicators. For the pair that did not use the definitions, agreement was poor. CONCLUSION: There was an increase in uniformity and accuracy between the assessments when using the conceptual and operational definitions for the nursing outcome indicators related to Breastfeeding establishment. IMPLICATIONS FOR NURSING PRACTICE: This study contributed to the development of terms within the Nursing Outcomes Classification, and enriched the body of nursing knowledge.

Impact of continuous vigilance monitoring on nursing workflow.

BACKGROUND: Increasing nursing time in patient care is beneficial in improving patient outcomes, but this is proving increasingly difficult with the nursing shortage, budgetary constraints, and higher patient acuity. OBJECTIVE: Nursing workflow was evaluated after the implementation of a continuous vigilance monitoring system to determine if the system enhanced patient-centric nursing care. METHODS: Work sampling observations were conducted at 3 hospitals for 6 categories of nursing activities (direct and indirect nursing, documentation, administrative, housekeeping, and miscellaneous) at baseline and at 3 and 9 months. RESULTS: Statistically significant increases in direct (3 months) and indirect nursing care (3 and 9 months) were found, with variability between sites. Statistically significant increases at 3 and 9 months for documentation of patient care activities and decreases in administrative activities were the most consistent findings for all sites. CONCLUSION: Continuous vigilance monitoring enhanced patient-centric care with increases in direct and indirect nursing care and documentation of those activities.

"Call for the Use of Axial Terms": Toward Completeness of NANDA-I Nursing Diagnoses Labels.

PURPOSE: This article explores the current structure of NANDA-I nursing diagnoses (ND) labels. METHODS: Critical analysis of the ND labels, as categorized in the NANDA-I terminology. FINDINGS: Most of the 244 ND labels are composed of terms from the focus and judgment axes. CONCLUSIONS: The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II. IMPLICATIONS FOR NURSING PRACTICE: Improvements in NANDA-I diagnosis labels would contribute to an advanced terminology and to increased specificity and accuracy of the diagnostic process that is needed in clinical practice. Completeness of the ND labels would reflect clinical reasoning preciseness and help students and nurses in delivering more personalized, safe, and effective patient-centered care. OBJETIVO: Este artigo explora os títulos dos diagnósticos de enfermagem da NANDA-I. MÉTODOS: Análise crítica dos títulos dos diagnósticos de enfermagem da NANDA-I. RESULTADOS: A maioria dos 244 diagnósticos de enfermagem classificados são compostos essencialmente por termos referentes ao foco e ao julgamento. CONCLUSÕES: A especificidade das respostas às transições de saúde e vida pode não estar totalmente representada nos dois eixos mais comuns, como apresentado na taxonomia II. IMPLICAÇÕES PARA A PRÁTICA: Melhorias nos diagnósticos da NANDA-I em relação ao seu aspeto multiaxial contribuiriam no desenvolvimento da sua terminologia e poderiam melhorar a especificidade e acurácia do processo diagnóstico que é necessário à prática clínica. Complementar os títulos dos diagnósticos de enfermagem poderia refletir a acurácia do raciocínio clínico e ajudar os estudantes e enfermeiros em prestarem cuidados centrados no paciente mais personalizados, seguros e eficazes.

Frequency of Respiratory Nursing Diagnoses and Accuracy of Clinical Indicators in Preterm Infants.

PURPOSE: To identify the frequency of the nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation in newborns; and, to analyze the accuracy of diagnostic indicators identified for each of these diagnoses. METHODS: This was a cross-sectional study conducted with a nonprobability sample of 92 infants. Data collected were represented by demographic and clinical variables, clinical indicators of the three respiratory nursing diagnoses from NANDA International, and were analyzed according to frequency and agreement between pairs of expert nurses (Kappa). FINDINGS: Ineffective breathing pattern was identified in 74.5% of infants; impaired gas exchange was noted in 31.5%; impaired spontaneous ventilation was found in 16.8% of subjects. Use of accessory muscles to breathe showed the highest sensitivity for ineffective breathing pattern; abnormal blood gases had the best predictive value for impaired gas exchange. Use of accessory muscles to breathe had the highest sensitivity for impaired spontaneous ventilation. CONCLUSIONS: Ineffective breathing pattern was the most frequently identified; use of accessory muscles, alteration in depth of breathing, abnormal breathing, and dyspnea were the most representative signs/symptoms. IMPLICATION FOR NURSING PRACTICE: Early recognition of respiratory conditions can support safe interventions to ensure appropriate outcomes.

Nursing diagnosis: is it time for a new definition?

PURPOSE: The Diagnosis Development Committee (DDC) of NANDA International frequently receives proposed "physiologic" and "surveillance diagnosis" submissions that may not meet the current definition of nursing diagnosis (NANDA, 2007, p. 332). There has been a request for a vote on newly proposed definitions of nursing diagnosis, risk diagnosis, and syndromes. The purpose of this article is to provide information which enables members and interested nurses to continue the dialogue and to share their thoughts and also to consider the thoughts and information generated by the participants in the NANDA-I interest survey on the definition of nursing diagnoses. DATA SOURCES: An electronic survey of the current NANDA-I definitions, and potential changes to those definitions, was distributed via the NANDA-I Web site. This article summarizes the overall findings of that survey and provides an overview of commentary received from the 269 participants. CONCLUSIONS: It is necessary to continue the dialogue on this important decision and to provide a mechanism for input from members and interested nurses before reaching any conclusions on this subject. NURSING IMPLICATIONS: NANDA-I has been recognized as the leader in the development and implementation of nursing diagnoses and must act responsibly in assessing the changing and emerging trends in nursing practice and in responding to these trends.

A Shovel-Ready Solution to Fill the Nursing Data Gap in the Interdisciplinary Clinical Picture.

PURPOSE: To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES: Healthcare literature. DATA SYNTHESIS: AAN's plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine - Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS: Authors present recommendations for revisions to AAN's plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN's plan in the long term.

Causation and Validation of Nursing Diagnoses: A Middle Range Theory.

PURPOSE: To describe a predictive middle range theory (MRT) that provides a process for validation and incorporation of nursing diagnoses in clinical practice. DATA SOURCES: Literature review. DATA SYNTHESIS: The MRT includes definitions, a pictorial scheme, propositions, causal relationships, and translation to nursing practice. CONCLUSIONS: The MRT can be a useful alternative for education, research, and translation of this knowledge into practice. IMPLICATIONS FOR NURSING PRACTICE: This MRT can assist clinicians in understanding clinical reasoning, based on temporal logic and spectral interaction among elements of nursing classifications. In turn, this understanding will improve the use and accuracy of nursing diagnosis, which is a critical component of the nursing process that forms a basis for nursing practice standards worldwide.

Respiratory Nursing Diagnoses: Presenting Evidence for Identification of the Defining Characteristics in Neonatal and Pediatric Populations.

PURPOSE: To identify and summarize clinical data supporting selection of nursing diagnoses related to the respiratory system for pediatric and neonatal populations. METHOD: A literature review conducted in indexed publications was used. FINDINGS: The final sample consisted of 13 studies conducted in children with cardiac disease, respiratory infection, and asthma with nursing diagnoses such as ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance. CONCLUSION: The higher frequency defining characteristics were dyspnea, abnormal breathing pattern, use of accessory muscle to breathe, change in frequency and respiratory rate, decreased SaO2 , and agitation. IMPLICATION FOR NURSING KNOWLEDGE: This literature review may provide a basis for consideration of important diagnostic criteria in the pediatric population; however, clinical validation in different stages of development is critical for ensuring diagnostic accuracy.

Clinical indicators of ineffective airway clearance in children with acute respiratory infection.

The identification of clinical indicators with good predictive ability allows the nurse to minimize the existing variability in clinical situations presented by the patient and to accurately identify the nursing diagnosis, which represents the true clinical condition. The purpose of this study was to analyze the accuracy of NANDA-I clinical indicators of the nursing diagnosis ineffective airway clearance (IAC) in children with acute respiratory infection. This was a prospective cohort study conducted with a group of 136 children and followed for a period of time ranging from 6 to 10 consecutive days. For data analysis, the measures of accuracy were calculated for clinical indicators, which presented statistical significance in a generalized estimated equation model. IAC was present in 91.9% of children in the first assessment. Adventitious breath sounds presented the best measure of accuracy. Ineffective cough presented a high value of sensitivity. Changes in respiratory rate, wide-eyed, diminished breath sounds, and difficulty vocalizing presented high positive predictive values. In conclusion, adventitious breath sounds showed the best predictive ability to diagnose IAC in children with respiratory acute infection.

Outpatient Clinic for Health Education: Contribution to Self-Management and Self-Care for People With Heart Failure.

OBJECTIVE: To report the experience of an outpatient nursing education clinic caring for people with chronic heart failure. EXPERIENCE REPORT: In this service, qualified "listening," recreational educational actions about the disease and its treatment are conducted, based on the interventions from the Nursing Interventions Classification (NIC), as well as the evaluation of self-care behaviors with the outcomes from the Nursing Outcomes Classification (NOC). This article describes the practice of health education activities and the use of NANDA-I-NIC-NOC in a nursing clinic. CONCLUSION: The outpatient clinic supports client learning about the treatment of disease and stimulates self-control of health behaviors. IMPLICATIONS FOR NURSING PRACTICE: This experience report will guide nurses in the establishment of outpatient nursing education clinics for different populations of patients with chronic health conditions.

Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit.

OBJECTIVE: To describe the nursing clinical judgment as a basis for ND identification and development of a NIC treatment plan for a child after cardiac surgery under intensive care. METHOD: A case study with data retrospectively collected from charts. RESULTS: Three nurses identified NANDA-I diagnoses and NIC interventions. A 6-month-old child submitted to cardiac surgery, requiring extracorporeal membrane oxygenation in the postoperative period. Four main nursing diagnoses were identified, towards which ten interventions were directed. The proposal of interventions to respond to the priority human responses of the child was optimized by the use of standard terminologies. Every nursing diagnosis was supported by diagnostic indicators; every intervention was scientifically supported. CONCLUSION: There must be an expectation that nurses address not only physiological responses, but also those within psychosocial domains.

Contexts for the study of the economic influence of nursing diagnoses on patient outcomes.

PURPOSE: To examine the historical, legal/ organizational, informatics, clinical, economic, and policy contexts underlying economic consequences of nursing diagnoses on patient outcomes. DATA SOURCES: Published literature, online material. DATA SYNTHESIS: Nursing diagnoses influence diagnostic-specific patient outcomes and other outcome variables such as length of hospital stay, morbidity, and mortality. CONCLUSIONS: Examination of the economic ramifications of nursing diagnosis on patient outcomes can be facilitated using standardized language and databases containing nursing-sensitive measures.

Construction and validation of a data collection tool for the clinical assessment of human responses of outpatients with chronic cardiovascular diseases.

PURPOSE: To develop and test the content validity of a nursing assessment tool for data collection (NATDC) based on NANDA-I for use in outpatients with chronic cardiovascular diseases. METHODS: Construction based on the literature, refinement with a pilot group of hypertensive outpatients and content validation by experts. FINDINGS: The NATDC questions were divided into demographic information of the patient and family, clinical data, physical examination, and interview according to NANDA-I domains. CONCLUSION: The NATDC was constructed and validated. IMPLICATIONS FOR NURSING PRACTICE: This tool can be used in patients with chronic illnesses who experience a variety of human responses seeking nursing care in an outpatient setting because it is based in human responses within a structured framework for nursing assessment.

Construction and validation of an instrument for assessment of the nursing diagnosis, risk for infection, in patients following cardiac surgery.

PURPOSE: To construct and validate a data collection instrument (DCI), and a corresponding instructional guide, for assessment of the nursing diagnosis, risk for infection, in patients following cardiac surgery. METHODS: Construction of conceptual and operational definitions for risk factors based on literature, content validation by experts, and clinical validation by clinical nurses. FINDINGS: There were significant internal consistency and reproducibility in the content validation. In the clinical validation, agreement among nurses was higher than 70% for all risk factors. CONCLUSIONS: The DCI was constructed and validated. IMPLICATIONS FOR NURSING PRACTICE: This DCI could be used for assessment of adult patients after cardiac surgeries worldwide because of its detailed cues for risk factors, which facilitate clinical reasoning and diagnostic judgment.

Ineffective breathing pattern: defining characteristics in children with acute respiratory infection.

PURPOSE: To determine the accuracy of NANDA-I defining characteristics for the nursing diagnosis, ineffective breathing pattern, in children with acute respiratory infection. METHODS: This was a prospective cohort study in 136 children. Measures of accuracy were calculated for the defining characteristics. FINDINGS: Use of accessory muscles to breathe presented the best measure of accuracy. Alterations in depth of breathing presented a high value of sensitivity. Altered chest excursion and orthopnea presented high values of specificity. CONCLUSIONS: Use of accessory muscles to breathe showed the best predictive capacity for ineffective breathing pattern. IMPLICATIONS FOR NURSING PRACTICE: Measures of accuracy can contribute to an accurate diagnostic inference process, improving patient assessment and facilitating rapid, accurate diagnosis.

[Contribution of standardized languages for knowledge production, clinical reasoning and clinical nursing practice]. / Contribuição das linguagens padronizadas para a produção do conhecimento, raciocínio clínico e prática clínica da Enfermagem.

The standardized language systems are important tools for dealing with the increasing complexity of nursing care. In this article the authors present the main benefits that the use of these systems provide for the required clinical reasoning in nursing care, the construction and organization of knowledge of the discipline, and for the clinical practice of nursing. The potential contributions of the standardized language systems in these fields stem from the fact that these systems provide a formal structure for supporting clinical reasoning, organizing knowledge and nursing experience.

Concept analysis and validation of the nursing diagnosis, delayed surgical recovery.

OBJECTIVE: To analyze the human response of delayed surgical recovery, approved by NANDA-I, and to validate its defining characteristics (DCs) and related factors (RFs). METHOD: This was a two-part study using a concept analysis based on the method of Walker and Avant, and diagnostic content validation based on Fehring's model. RESULTS: Three of the original DCs, and three proposed DCs identified from the concept analysis, were validated in this study; five of the original RFs and four proposed RFs were validated. CONCLUSIONS: A revision of the concept studied is suggested, incorporating the validation of some of the DCs and RFs presented by NANDA-I, and the insertion of new, validated DCs and RFs. IMPLICATIONS FOR NURSING PRACTICE: This study may enable the extension of the use of this diagnosis and contribute to quality surgical care of clients.