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.

"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.

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.

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...

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.

Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit / Diagnósticos y intervenciones de enfermería para una niña en el postoperatorio de cirugía cardiaca en unidad de cuidados intensivos

Objetivo: descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva. Método: estudo de caso com coleta de dados retrospectiva no prontuário. Resultados: três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas. Conclusão: espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais. .

Objetivo: describir el raciocinio clínico de enfermería para identificar diagnósticos y planear intervenciones NIC para una nina en el postoperatorio de cirugía cardíaca. Método: estudio de caso con datos recogidos de forma retrospectiva en registros. Resultados: tres enfermeras propusieron diagnósticos NANDA-I e intervenciones NIC. Nina de 6 meses de edad, sometida a cirugía cardíaca requirió oxigenación por membrana extracorpórea en el postoperatorio. Cuatro principales diagnósticos fueron identificados para los cuales diez intervenciones de enfermería fueron direccionadas. La propuesta de intervenciones para las respuestas humanas prioritarias de la nina fue optimizada por el uso de terminologías estándar. Todos los diagnósticos fueron apoyados por indicadores, cada intervención apoyada científicamente. Conclusión: los enfermeros deben abordar no sólo las respuestas fisiológicas, sino también los dominios psicosociales. .

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.

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.

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.

Uma revisão da literatura neonatal para identificar atributos críticos para diagnósticos de enfermagem de hipotermia / A review of neonatal literature to identify critical attributes for hypothermia nursing diagnoses / Una revisión de la literatura neonatal para identificar los atributos críticos para los diagnósticos de enfermería de hipotermia

O objetivo deste estudo foi explorar indicadores diagnósticos na população neonatal para um diagnóstico de enfermagem aprovado pela NANDA International, Inc., hipotermia, e para um diagnóstico proposto, o risco de hipotermia. Nesta revisão, 23 artigos foram revisados ​​a partir da CINAHL, PubMed e Lilacs no período de janeiro a abril de 2013. Os dados foram extraídos dos artigos e sintetizados para desenvolver uma lista de potenciais fatores relacionados e/ou de risco e características definidoras. Potenciais características definidoras e fatores relacionados associados a recém-nascidos foram identificados para testes clínicos em hipotermia, (23 e 17, respectivamente). Vinte e três fatores de risco foram identificados para o risco de hipotermia. Indicadores diagnósticos para diagnósticos de enfermagem que colocam os recém-nascidos em situação de risco de morbidade e mortalidade permitirão triagem e avaliação de riscos mais adequadas. Estes indicadores diagnósticos recentemente identificados exigem investigação para validar a sua utilidade clínica.

The aim of this study was to explore diagnostic indicators in the neonatal population for one nursing diagnosis approved by NANDA International, Inc., hypothermia, and for a proposed diagnosis, risk for hypothermia. In this integrative review, 23 articles were reviewed from the Cinahl, PubMed, and LILACS databases during the period of January through April, 2013. Data were drawn from the articles and synthesized to develop a list of potential related and/or risk factors, and defining characteristics. Potential newborn-related defining characteristics and related factors were identified for clinical testing in hypothermia, (23 and 17, respectively). Twenty-three risk factors were identified for risk for hypothermia. Diagnostic indicators for nursing diagnoses that place newborns at risk of morbidity and mortality will enable risk screening and more adequate assessments. These newly identified diagnostic indicators require research to validate their clinical usefulness.

El objetivo del estudio fue explorar indicadores diagnósticos en neonatos para diagnóstico de enfermería aprobado por NANDA International, Inc., hipotermia, y para uno diagnóstico propuesto, el riesgo de hipotermia. En esta revisión integradora, 23 artículos fueron revisados de CINAHL, PubMed y Lilacs, de enero a abril de 2013. Los datos fueron extraídos de los artículos y sintetizados para desarrollar una lista de potenciales factores relacionados y/o de riesgo y características definitorias. Se identificaron potenciales características definitorias y factores relacionados asociados a los recién nacidos durante las pruebas clínicas en hipotermia (23 y 17 respectivamente). Veintitrés factores de riesgo se identificaron para el riesgo de hipotermia. Indicadores diagnósticos para diagnósticos de enfermería que ponen a los recién nacidos en riesgo de morbilidad y mortalidad permitirán detección y evaluación de riesgos más apropiadas. Estos indicadores diagnósticos recientemente identificados requieren investigaciones para validar su utilidad clínica.

[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.

Contribuição das linguagens padronizadas para a produção do conhecimento, raciocínio clínico e prática clínica da Enfermagem / Contribution of standardized languages for knowledge production, clinical reasoning and clinical Nursing practice / Contribución de los lenguajes estandarizados para la producción del conocimiento, razonamiento clínico y práctica clínica de Enfermería

Os sistemas de linguagens padronizadas são instrumentos importantes para lidar com a crescente complexidade do cuidado de enfermagem. Neste artigo os autores apresentam os principais benefícios que o uso desses sistemas oferece para o raciocínio clínico requerido no cuidado de enfermagem, para a construção e organização do conhecimento da disciplina e para a prática clínica de enfermagem. As potenciais contribuições dos sistemas de linguagens padronizadas nesses campos derivam do fato de tais sistemas oferecerem estrutura formal para apoiar o raciocínio clínico, organizar o conhecimento e a experiência de 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.

Los sistemas de lenguajes estandarizados son herramientas importantes para hacer frente a la creciente complejidad de los cuidados de enfermería. En este artículo los autores presentan los principales beneficios que el uso de estos sistemas ofrece para el razonamiento clínico requerido en los cuidados de enfermería, para la construcción y organización del conocimiento de la disciplina, y para la práctica clínica de la enfermería. Las posibles contribuciones de los sistemas de lenguajes estandarizados en estos ámbitos se derivan del hecho de que estos sistemas proporcionan una estructura formal para apoyar el raciocinio clínico, organizar la experiencia y los conocimientos de enfermería.

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.