Processes and methodologies for research validation of nursing diagnoses.

TOPIC: Research validation of nursing diagnoses. PURPOSE: To provide a historical review of processes and methodologies for research validation of nursing diagnoses and suggested directions for future nursing diagnosis research. SOURCES: Nursing diagnosis research methodologies and processes from the Invitational Conference on Research Methods for Validating Nursing Diagnoses, Nursing Diagnosis: The Journal of Nursing Language and Classification, and the North American Nursing Diagnosis Association (NANDA) conference proceedings for the first through the 12th conference. CONCLUSIONS: Future nursing diagnosis research should include concept analysis, expert validation, clinical validation, instrument development, larger studies, powerful statistical analyses, replication and comparison of studies, and concerted efforts to support group research activities that target priority areas of research.

Graduate student-faculty collaboration in research and publication.

The nursing profession advocates development of theoretical knowledge as a basis for nursing practice and promotes preparation of graduate students as nursing scholars. This study explored the influence of selected factors on the publishing efforts of student authors who published in the Western Journal of Nursing Research during a 5-year period. Assignments, particularly for a dissertation, provided a significant impetus for publishing. Self-selection of a topic of interest also was an important factor. Approximately one third of the student authors had collaborated with faculty as coauthors. Graduate students make a significant contribution to the creation and dissemination of nursing knowledge. The influence of collaboration with faculty, the defining elements of collaborative mentorship, and inherent ethical issues should be investigated in future studies.

Factors influencing the publishing efforts of graduate students in nursing.

The purposes of this study were to identify factors influencing publication efforts of graduate students in nursing and determine the extent to which graduate students' scholarly activities contribute to the creation and dissemination of knowledge in nursing, as evidenced by publication in a professional journal. Authors of articles in Nursing Research were surveyed to assess their status as graduate students during the conceptualization, development, and publication of nursing research studies. The sample consisted of 633 authors of manuscripts published in Nursing Research from 1987 to 1991. The study design was descriptive. A survey questionnaire elicited data on graduate student status and factors that influenced the initiation and completion of the project. The data were analyzed using descriptive statistical techniques. The results of the study suggest that graduate students in nursing make important contributions to the advancement and dissemination of nursing knowledge. Factors that influence graduate students to engage in the process include academic requirements (e.g., thesis, dissertation, coursework), faculty involvement and support, and the ability to self-select the research topic.

Three phases of research in validating nursing diagnoses.

The purposes of this three-phase project consisting of concept analyses, nurse expert validation, and client validation were: identification of nursing definitions of anxiety and fear, validation of defining characteristics of the diagnoses by nurse experts, differentiation of the diagnoses by nurse experts, and validation of the nursing diagnosis anxiety by clients. The nurse expert sample consisted of 233 professional nurses, and the client sample consisted of 69 adult clients. Results include agreement on two critical defining characteristics of anxiety by nurse experts and clients, the differentiation of anxiety and fear by nurse experts, the suggestion of a fear-anxiety syndrome in the literature and by nurse experts and clients, and the suggestion by nurse experts that anxiety be defined using levels of anxiety. Recommendation for changes in the nursing diagnosis anxiety are discussed.

A multivariate approach for validation of anxiety and fear.

The purpose of this study was to reduce the defining characteristics for the nursing diagnoses anxiety and fear into sets of smaller, more manageable and meaningful variables for clinical use and further investigation. A sample of 233 nurse experts rated defining characteristics of anxiety and fear on three study instruments; a sample of 69 hospitalized clients rated defining characteristics of anxiety on one study instrument. Results of principle components analyses identified patterns within defining characteristics and provided consolidation of characteristics into meaningful and usable sets.

The impact of violence in the health care setting upon nursing education.

As the incidence of violence and potential risks for violence have increased in the health care workplace, the safety of nurses and nursing students has emerged as a critical concern for the profession. This article provides a review of the literature focusing on the incidence of violence toward nurses, factors that contribute to the occurrence of violence, the management of violent or potentially violent situations, and the effects on nurse victims of violence. Additionally, the costs of violence to the health care system and the various ways that violence has been defined are reviewed. The literature on violence occurs primarily in the clinical specialty areas of psychiatric-mental health, emergency department, long-term care, and home care nursing. To address the need to prepare students to deal with the issue of violence in the health care setting, strategies for nursing education are presented which include role playing, videotape playbacks, and debriefing sessions. Suggested content consists of student self-awareness, assessment, and diagnosis of violent or potentially violent clients, and nursing care planning, interventions, and evaluation for the immediate situation, as well as long-term treatment goals. The authors emphasize the obligation of nurse educators to prepare students to deal with violence in the health care setting.

Barriers to the use of nursing diagnosis language in clinical settings.

Ongoing evaluation of the use of nursing diagnoses at the clinical level is critical to the facilitation of further development and refinement of the language of nursing. Therefore, the purpose of this study was to identify the status of utilization of nursing diagnosis in Illinois. A survey instrument was mailed to 239 Illinois hospitals 139 (58%) responded. Results included: 78% of the responding hospitals had implemented nursing diagnosis, with almost all (95%) utilizing NANDA terminology. Components of continuing education efforts related to nursing diagnosis were identified by 75% of the hospitals. Ongoing monitoring of quality improvement methods was reported by 45% of the respondents. The barriers to implementation cited most frequently included: limited ongoing education, lack of motivation to learn, or nurses' difficulties in adjusting to its use.

Expert validation and differentiation of the nursing diagnoses anxiety and fear.

In this study, the author (a) identifies and validates critical and supportive characteristics of the nursing diagnosis anxiety, and (b) differentiates the defining characteristics of the nursing diagnosis anxiety from the nursing diagnosis fear. The sample consisted of 233 nurses with a master's degree in psychiatric-mental health nursing or medical-surgical nursing. The study design followed the nurse validation model of Gordon and Sweeney (1979) as expanded by Fehring (1986, 1987). Following concept analyses of anxiety and fear, the author developed three instruments for rating characteristics as to how representative they were of fear or anxiety. Three critical defining characteristics were identified for anxiety and six critical defining characteristics were identified for fear. Nurses differentiated between the two diagnoses but also suggested the presence of a fear-anxiety syndrome in some clients.

Contributions of graduate students to the creation and dissemination of nursing knowledge.

The purpose of this study was to determine the extent to which graduate students' research and scholarly activities, as evidenced by publication, contribute to the creation and dissemination of knowledge in nursing. Authors of articles published in IMAGE: Journal of Nursing Scholarship were surveyed to assess their status as graduate students during the conceptualization, development and publication of research or scholarly papers. The sample consisted of 332 authors of manuscripts published in IMAGE from 1986 through 1990. The study design was descriptive. A survey questionnaire elicited data on graduate student status and factors that influenced the initiation and completion of the published work. Descriptive statistical techniques were employed to analyze the data. The results of this study suggest that graduate education in nursing makes an important contribution to the advancement and dissemination of nursing knowledge.

Concept analysis of fear.

The nursing diagnosis fear is clarified through the technique of concept analysis. Uses of the concept of fear in prominent theories of human behavior and in nursing are reviewed. Five critical attributes occurring in all cases of fear are identified--a model case, a related case, a contrary case, and an illegitimate case are presented. Antecedents to fear are derived. Consequences of fear are discussed and are related to nursing interventions. Empirical referents that demonstrate occurrence of the concept of fear are determined, classified, and related to critical attributes. This concept analysis provides an essential conceptual base for instrument development and clinical research on fear.

Concept analysis of anxiety.

Anxiety, a nursing diagnosis that impacts clients in all settings and nurses throughout the profession, is clarified through the technique of concept analysis. Uses of the concept of anxiety in prominent theories of human behavior and in nursing are reviewed. Four critical attributes occurring in all cases of anxiety are identified--model cases, a related case, a contrary case, and an illegitimate case are presented. Antecedents to anxiety are identified. Consequences of anxiety are discussed. Empirical referents that demonstrate occurrence of the concept of anxiety are determined, classified, and related to critical attributes. This concept analysis provides an essential conceptual base for instrument development and clinical research on anxiety.

Ritualistic behavior: breaking the cycle.

1. Recent studies reveal that OCD occurs at rates of 25 to 60 times greater than previous estimates. 2. Currently, biological theories of causation have been cited by multiple researchers. 3. Behavioral therapy and medication therapy have emerged as treatments of choice in OCD.

Noncompliance: an update.

Health care providers have focused much attention on the area of patient compliance during recent decades. With the establishment of noncompliance as a nursing diagnosis, attention to this issue by nurses has continued and has included controversy. This study reported herein explored the use of noncompliance as a nursing diagnosis in clinical practice, the defining characteristics necessary for arriving at the diagnosis of noncompliance, and alternative diagnoses used if noncompliance is not used. A survey questionnaire was completed by 104 nurses who reside in Illinois and are members of the North American Nursing Diagnosis Association (NANDA). Fifty-three of the respondents reported that they do not. Conclusions derived from the study include: (1) Questions continue to exist regarding the acceptability/utility of this diagnosis; (2) respondents generally indicated consensus with the NANDA listing of defining characteristics and etiologies but identified additional characteristics and etiologies.

Altered parenting and the reconstituted family.

Reconstituted families are a high incidence phenomena in contemporary society. Because the family continues to be a focus for the delivery of nursing care, nurses must now address the special needs of individuals who are members of reconstituted families. Studies in this area provide important background information regarding behavioral patterns in reconstituted families that can be used for assessment and intervention with these families. Through the use of focused assessment parameters, nurses can collect data that will indicate the special needs of members of reconstituted families. In general, nursing interventions with clients who are a part of a reconstituted family fall into two major categories: (a) developing positive parenting behaviors, and (b) protecting the development of the stepchild.