Digital Health Literacy Instrument: Brazilian Version-Cross-Cultural Adaptation and Content Validity for Individuals With Heart Failure.

Background and purpose: Assessment of digital health literacy should be a major concern for healthcare providers. We aimed to translate and adapt the Digital Health Literacy (DHL) Instrument into Brazilian Portuguese and examine the content validity for individuals with heart failure (HF). Methods: The instrument was translated, back translated, and evaluated by a panel of six experts regarding linguistic equivalences. An agreement analysis was performed, with values ≥80% considered acceptable. The experts then evaluated clarity, theoretical relevance, and practical pertinence. The content validity index (CVI) was calculated for each item. A CVI ≥.83 was considered acceptable. The expert's opinions were also evaluated through the modified kappa coefficient for content validity studies. Values >.74 were considered excellent. The content validity ratio (CVR) was also calculated. A critical value of CVR of 1.00 was determined. Cognitive testing (understanding the meaning of each item and their respective answers) was performed with 33 individuals with HF. Results: The adapted version obtained an agreement of ≥83.3% for each item on linguistic equivalences. Total CVI was ≥0.83, kappa values for each item were >.74, and the CVR values were 1.00 for all items. After two rounds of evaluation, all patients were able to understand the items and response scale. Conclusions: The Brazilian version has satisfactory evidence of linguistic and content validity to measure DHL in patients with HF. Additional psychometric properties will be tested in the country.

Control Attitudes Scale-Revised-Brazilian Version.

BACKGROUND: Heart failure demands self-care skills and behaviors that can be negatively impacted by a low level of perceived control (PC), a belief about having the necessary resources to deal with negative events. Having valid and reliable instruments to measure PC is important to support interventions that improve self-care and related outcomes. The Control Attitudes Scale-Revised (CAS-R) was developed in the United States to measure PC in cardiac conditions. In Brazil, there are no instruments available to measure this construct. OBJECTIVE: The aims of this study were to translate and adapt the CAS-R to the Brazilian population and to assess the content validity of the adapted version. METHODS: The CAS-R was translated, back-translated, and assessed by an expert committee for linguistic equivalences. An agreement > 80% was considered adequate. Content validity (clarity, theoretical relevance, and practical pertinence) was assessed by both an expert professional panel (n = 6-8) and a panel of patients with heart failure (n = 40). A content validity coefficient > 0.70 was considered acceptable. RESULTS: The translations to Brazilian Portuguese were considered consistent with the original CAS-R. In the third round of linguistic equivalence assessment, all items achieved acceptable agreement, except for 2 items. After modifications to the instrument to achieve adequate equivalences, the adapted version had a final content validity coefficient of 0.93. Most patients were able to understand the instrument. CONCLUSIONS: The CAS-R-Brazilian version is equivalent to the original CAS-R and has satisfactory evidence of content validity. Additional psychometric testing will be performed to allow for the assessment of PC in individuals with heart failure in Brazil.

Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care.

PURPOSE: Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients. DATA SOURCES: A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element. DATA SYNTHESIS: Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations. CONCLUSIONS: This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations. IMPLICATIONS FOR NURSING PRACTICE: This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.

Symptom Status Questionnaire - Heart Failure - Brazilian Version: cross-cultural adaptation and content validation.

BACKGROUND: In Brazil, there are no instruments available to measure the presence, frequency, severity and distress related to heart failure (HF) symptoms. AIMS: To adapt the Symptom Status Questionnaire - HF (SSQ-HF) into Brazilian Portuguese and to examine the content validity of the adapted version. METHODS: The instrument was translated, back-translated and evaluated by an expert committee for semantic, idiomatic, cultural, and conceptual equivalences. An agreement ≥80% was considered adequate. The adapted version was evaluated by both an expert committee (n = 9) for clarity, theoretical relevance and practical relevance (acceptable content validity coefficient (CVC): ≥0.70), and by a patient committee regarding understanding (n = 40). RESULTS: The adapted version obtained 100% agreement regarding the equivalences. The total instrument CVC was 0.99. All patients understood the items. CONCLUSION: The SSQ-HF-Brazilian version has satisfactory evidence of equivalence and content validity. Additional psychometric tests are deemed to confirm that the instrument can be used in Brazil.

Content validation of the nursing outcome Knowledge Heart Failure Management: Brazilian nurses' opinions.

PURPOSE: To estimate the content validity of the outcome Knowledge: Heart Failure Management (1835) of the Nursing Outcomes Classification (NOC). METHODS: A methodological study conducted in Brazil with nurses with expertise in cardiovascular nursing and nursing process. The nurse experts evaluated the relevance of the indicators for the nursing outcome on a 5-point Likert scale. A total of 55 indicators were analyzed, including 50 NOC indicators, four indicators located from a scoping review, and one suggested by an expert during the content validation process. The relevance ratio supported the categorization of indicators as critical, supplemental, or unnecessary. Relevance ratios of critical and supplemental indicators were summed and divided by the total number of the indicators to calculate the outcome content validity (OCV) score of the nursing outcome. FINDINGS: Fifteen nurse experts, mostly females (n = 13) with a mean age of 36.0 ± 6.3 years, 13.9 ± 6.5 years of professional experience, and extensive use of the nursing process in their clinical practice (n = 10), teaching (n = 13), and research (n = 11), participated in this study. Regarding the content validation, 43 (78.2%) out of 55 indicators were categorized as critical (relevance ratio .80-.98), 11 (20%) as supplemental (relevance ratio .67-.79), and one indicator (1.8%) was categorized as unnecessary (relevance ratio .48). The OCV score of the nursing outcome was .87. CONCLUSION: The study provided evidence of content validity of 49 indicators of the NOC outcome, Knowledge: Heart Failure Management, and five new indicators identified through the validation process based on nurse experts' opinions. IMPLICATIONS FOR THE NURSING PRACTICE: These findings provide evidence-based indicators for the measurement of heart failure patients' knowledge about disease management. As a result, nurses can test the effectiveness of nursing interventions based on valid outcome indicators.

International Collaboration and New Research Evidence on Nanda International Terminology.

OBJECTIVES: To discuss priorities and possibilities for promoting international collaboration and new research evidence on NANDA International, Inc. (NANDA-I). METHODS: Theoretical reflection article based on the literature and the authors' opinions on the subject matter, carried out by six research nurses. CONCLUSIONS: International research collaboration for NANDA-I allows the improvement of research production in an actual clinical setting, especially with multicenter and validation studies, conducted by researchers from different countries. This provides for improved understanding of patients' experiences and may help to produce robust scientific evidence. IMPLICATIONS FOR NURSING KNOWLEDGE: The generation of new evidence may lead to an increase in NANDA-I visibility and in nurses' understanding of its meaning for clinical practice and for the formulation of diagnostic hypotheses.

Cross-cultural adaptation of the caregiver contribution to heart failure self-Care into Brazilian Portuguese and content validation.

BACKGROUND: The Caregiver Contribution to Heart Failure Self-Care (CACHS) is a Canadian instrument that assesses caregivers' (CGs) contributions to heart failure (HF) patients' self-care, but a Brazilian version was lacking. AIMS: To adapt CACHS into Brazilian Portuguese and to estimate the content validity of the adapted version. METHODS: A psychometric study of cross-cultural adaptation and content validation was conducted. Linguistic equivalence was assessed by eight professional experts. Content validity was assessed by an expert professional panel (n=8; for clarity, theoretical relevance and practical relevance) and a CG panel (n=46; for cognitive debriefing of the adapted instrument). In the cultural adaptation, the items were considered equivalent if experts reached an agreement ≥80%. In the content validation, the items were considered acceptable if content validity coefficients (CVC) were ≥0.70. RESULTS: The translated version was considered consistent with the original CACHS by the authors. In the second round of linguistic equivalence assessment, all items achieved 100% agreement, except for one item, which presented 75% agreement in conceptual equivalence. The CVC in the first and second rounds of content validity assessment by experts was 0.80 to 0.90. During cognitive testing, the CGs requested explanations on three items, which were reformulated. All CGs then understood the Brazilian version of CACHS, named CACHS - Versão Brasileira (CACHS-Br). CONCLUSIONS: CACHS-Br is equivalent to the original version and provided satisfactory evidence of content validity. Further psychometric testing of this version should allow for the measurement of the CG contributions to HF self-care in Brazil.

Risk of venous thromboembolism and implementation of preventive measures. / Riesgo de tromboembolismo venoso e implementación de medidas preventivas.

OBJECTIVE: To identify the frequency of risk factors for venous thromboembolism in hospitalized medical patients and the use preventive measures by healthcare professionals. METHOD: A descriptive, cross-sectional, retrospective study including medical charts of 369 adult patients hospitalized in the Medical sector of a university hospital in São Paulo, Brazil, for at least 48h from 2015 to 2017. Sociodemographic data, clinical risk factors for venous thromboembolism, contraindication and implementation of chemical prophylaxis, and the occurrence of the disease were investigated. The use of preventive measures was calculated by following the guidelines of the Brazilian Society of Clinical Medicine and the risk of venous thromboembolism according to the Padua Prediction Score (high risk ≥ 4 and low risk < 4). RESULTS: The prevalence of venous thromboembolism was 7.3% (n = 27). All patients had at least one risk factor for venous thromboembolism, the most prevalent being reduced mobility (74.2%), active cancer (70.7%), infection (27.1%), recent surgery (21.6%) and age ≥70 years (20.0%). Chemical prophylaxis was implemented in 70.3% of high-risk patients without contraindication and mechanical prophylaxis was applied in only one of the cases with an indication. CONCLUSIONS: All patients had at least one risk factor for venous thromboembolism. However, there was a low rate of implementation of preventive measures by health care professionals. Therefore, there is a need for multiple interventions, including admission and permanent education of nurses regarding risk and prevention, warning systems and outcomes audit.

Efficacy of a video during bed bath simulation on improving the performance of psychomotor skills of nursing undergraduates: A randomized clinical trial.

BACKGROUND: Studies have shown the efficacy of videos used in isolation to retain knowledge, acquire skills, and establish students' self-confidence. A few studies have investigated the efficacy of videos associated with simulations, while none of these studies have addressed bed bathing, one of the first procedures learned by nursing students. OBJECTIVE: To test the efficacy of a video-assisted bed bath simulation on improving the performance of psychomotor skills of undergraduate nursing students. DESIGN: A randomized clinical trial. SETTING: A Teaching Skills and Simulation Center at a Federal University in Brazil. PARTICIPANTS: All students regularly enrolled in the second year of the nursing undergraduate program at a Federal University, aged 18 years old, who had never performed a bed bath and had attended a theoretical class addressing the procedure (n = 56). METHODS: The students were randomized into two groups: the Control group (n = 28) simulated a bed bath with the instructions of a tutor, while the Intervention group (n = 28) watched a video during the bed bathing simulation, under the supervision of a tutor. The performance of students concerning bed bathing was assessed twice (before and after the simulation) using a previously validated instrument. RESULTS: The psychomotor skills of both groups significantly improved in the second assessment, and the Intervention group scored higher (p = 0.003). CONCLUSIONS: The use of a video during bed bath simulations was efficacious for improving the performance of psychomotor skills of undergraduate nursing students.

Clinical Predictors of Risk for Decreased Cardiac Tissue Perfusion After Percutaneous Coronary Intervention: A Retrospective Cohort Study.

OBJECTIVE: To establish clinical predictors of risk for decreased cardiac tissue perfusion (DCTP) after percutaneous coronary intervention (PCI). METHODS: Data on demographic, anthropometric, clinical, and procedural variables were collected as explanatory from a database of 1,542 adult patients undergoing PCI. A diagnosis of periprocedural myocardial infarction was used to confirm DCTP. A multivariate logistic regression determined the predictors of DCTP. RESULTS: The independent predictors of risk for DCTP were age (OR = 1.02, CI 95% = 1.01-1.03, p = .008), multivessel disease (OR = 1.79, CI 95% = 1.30-2.46, p <.001) and intraprocedural lesion complications (OR = 4.56, CI 95% = 3.03-6.87, p <.001). CONCLUSION AND IMPLICATIONS FOR NURSING PRACTICE: These results increase the level of evidence of risk for DCTP by refining its risk factors and can support nurses' clinical judgment.

Prevalence and Associations Between Related Factors and Defining Characteristics of the Nursing Diagnosis Sedentary Lifestyle in Patients with Acute Coronary Syndrome.

PURPOSE: To identify the prevalence of Sedentary Lifestyle (SL) and associations between its defining characteristics (DC) and related factors (RF) in patients with acute coronary syndrome (ACS). DATA SOURCES: 123 patients with ACS were assessed for SL through the International Physical Activity Questionnaire. Associations between DC and RF was investigated by Pearson's Chi square and Fisher's exact test. DATA SYNTHESIS: 56.1% had SL. Insufficient motivation and Insufficient resources for physical activity were associated with two DC. CONCLUSION: SL was frequent and there were associations between RF and DC. IMPLICATIONS FOR NURSING PRACTICE: Multi-professional interventions should aim at motivating patients to adopt physical activities.

Conceptual and Operational Definitions of the Defining Characteristics and Related Factors of the Diagnosis Ineffective Health Management in People With Heart Failure.

OBJECTIVE: To construct conceptual and operational definitions for the defining characteristics (DCs) and related factors (RFs) of the nursing diagnosis (ND) ineffective health management for people with chronic heart failure. METHOD: Conceptual and operational definitions for the DC and RF were based on studies found in an integrative literature review in the databases Latin American Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature, and MEDLINE by using the key words Nursing diagnosis, Heart Failure, and Patient Cooperation in different combinations. RESULTS: Conceptual and operational definitions for all the DCs and RFs were constructed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The definitions will facilitate in the identification of ND in clinical practice in patients with heart failure, future research on ND validation, and education in undergraduate courses.