Validade de conteúdo dos indicadores clínicos de desobstrução ineficaz de vias aéreas / Validez de contenido de los indicadores clínicos de desobstrucción ineficaz de las vías aéreas / Content validity of ineffective airway clearance clinical indicators

Resumo Objetivo Identificar os indicadores clínicos mais relevantes para o Diagnóstico de Enfermagem Desobstrução ineficaz de vias aéreas. Método Estudo metodológico de análise de conteúdo organizado em três fases: definição conceitual do fenômeno de interesse, construção da estrutura do fenômeno de interesse e análise dos juízes sobre a estrutura construída. Resultados Foram identificados 21 indicadores clínicos. Apenas Sons respiratórios aumentados e Retração subcostal não foram indicadores significativamente relevantes para o diagnóstico. Conclusão Os indicadores de maior relevância para o diagnóstico Desobstrução ineficaz de vias aéreas foram: Dispneia, Mudanças no ritmo respiratório, Ruídos adventícios respiratórios, Taquipneia, Acúmulo excessivo de muco, Tosse ineficaz, Sons respiratórios diminuídos, Ortopneia, Cianose, Inquietação, Dificuldade para verbalizar e Uso da musculatura acessória para respirar.

Resumen Objetivo Identificar a los indicadores clínicos más relevantes para el Diagnóstico de Enfermería Desobstrucción ineficaz de las vías aéreas. Métodos Estudio metodológico de análisis de contenido organizado em tres fases: definición conceptual del fenómeno de interés, construcción de la estructura del fenómeno de interés y análisis de los jueces sobre la estructura construida. Resultados Se identificaron 21 indicadores clínicos. Únicamente Sonidos respiratorios aumentados y Retracción subcostal no fueron indicadores significantemente relevantes para el diagnóstico. Conclusión Los indicadores de mayor relevancia para el diagnóstico Desobstrucción ineficaz de las vías aéreas fueron: Disnea, Cambios en el ritmo respiratorio, Ruidos adventicios respiratorios, Taquipnea, Acúmulo excesivo de mucosidad, Tos ineficaz, Sonidos respiratorios disminuidos, Ortopnea, Cianosis, Inquietud, Dificultad para verbalizar y Uso de la musculatura accesoria para respirar.

Abstract Objective To identify the most relevant clinical indicators for the Ineffective airway clearance Nursing Diagnosis. Method This is a methodological study of content analysis organized into a conceptual definition of the phenomenon of interest, construction of the phenomenon of interest structure and analysis by judges on the constructed structure. Results Twenty-one clinical indicators were identified. Only Increased breath sounds and Subcostal retraction were not significantly relevant for the diagnosis. Conclusion The most relevant indicators for the Ineffective airway clearance diagnosis were: Dyspnea, Alteration in respiratory rate, Adventitious respiratory noises, Tachypnea, Excessive sputum, Ineffective cough, Decreased breathing sounds, Orthopnea, Cyanosis, Restlessness, Difficulty verbalizing and Use of accessory muscles to breathe.

Constipation in Chemotherapy Patients: A Diagnostic Accuracy Study.

OBJECTIVE: To analyze the accuracy of clinical indicators of constipation in cancer patients undergoing chemotherapy. METHODS: A diagnostic accuracy study was conducted from February to September 2018, with 240 cancer patients undergoing chemotherapy. The data collection instrument was a form with sociodemographic and clinical variables, and clinical indicators of constipation. The sensitivity and specificity of the clinical indicators of interest were calculated using a latent class analysis approach. RESULT: The prevalence of constipation in the sample was 86.6%. The most sensitive clinical indicators were straining with defecation (100.0%), and hypoactive bowel sounds (75.0%), while headache (99.9%), abdominal pain (75.0%), pain with defecation (75.0%), straining with defecation (99.9%) and liquid stool (78.1%) were indicators with high specificity. CONCLUSION: A set of six clinical indicators was significantly associated with the occurrence of constipation in cancer patients undergoing chemotherapy, especially straining with defecation. These indicators can be used by nurses to identify constipation and propose prompt and effective interventions.

Content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects.

OBJECTIVE: To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. METHOD: Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05. RESULTS: The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy. CONCLUSION: The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.

Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation.

OBJECTIVE: To validate the defining characteristics of the nursing diagnoses, impaired memory and chronic confusion for older adults, by testing diagnostic concept definitions among expert nurses. METHODS: We used a Diagnostic content validation using an online survey of expert clinical nurses. RESULTS: 195 expert nurses performed the diagnostic validations. Findings provided validity of impaired memory with 11 major defining characteristics and chronic confusion, with 11 major and one minor defining characteristics. In both diagnoses, content validity index was 0.85. Factor analysis provided four and five supported factors for impaired memory and chronic confusion, respectively. CONCLUSION: The study provided evidence of validity of the two diagnoses and made them clearer. Using these updated nursing diagnoses, nurses have the potential to improve accuracy and quality of care for elderly patients, contributing to more accurate nursing gerontological care.

Content Validation of Clinical Evidence Related to Self-Care Deficits of Patients With Stroke.

OBJECTIVE: The aim of the study was to develop the conceptual and operational definitions for the defining characteristics of each nursing diagnosis related to self-care deficits of patients with stroke and to validate these definitions with experts. METHODS: This was a methodological study. The definitions were evaluated by 32 specialists and analyzed using binomial testing. RESULTS: All the defining characteristics analyzed were statistically significant (p < .05); three indicators showed agreement at a level lower than the ideal (<0.85). CONCLUSION: The definitions achieved validity for measuring self-care deficit for bathing, toileting, dressing, and eating. IMPLICATIONS FOR NURSING PRACTICE: These defining characteristics of each nursing diagnosis related to self-care deficits may enable more accurate assessment, driving relevant and individualized action plans in rehabilitation.

Developing and Testing the Diagnostic Accuracy of a Brief Nursing Dysphagia Screen.

PURPOSE: The aim of the study was to develop and test the Groppo-Lawless nurse-initiated screen designed to identify patients diagnosed with pneumonia who are at risk for dysphagia. DESIGN: This is a two-phase methodological study. METHODS: Phase 1 involved three steps. First, risk factors (n = 27) for dysphagia were identified from the literature. Next, frequency of these risk factors was calculated from a chart review of patients diagnosed with pneumonia (N = 301). Finally, frequency of risk factors among those patients who failed the 3-oz water trial (n = 56) were calculated, and a five-item instrument, the Groppo-Lawless Dysphagia Screen, was constructed. In Phase 2, nurses' results using the screen were compared to blinded results of speech-language pathologists. FINDINGS: Sensitivity (81.1%), specificity (96.4%), and diagnostic odds ratio (22.43) were calculated. CONCLUSIONS/CLINICAL RELEVANCE: Given the strong psychometric properties of this screen, its use by nurses may increase the number of appropriate speech-language pathologist referrals among patients diagnosed with pneumonia.

Precisión de las características definitorias del diagnóstico de enfermería termorregulación ineficaz en recién nacidos / Accuracy of the defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns

OBJETIVO: Identificar las medidas de precisión de las características definitorias del diagnóstico de enfermería termorregulación ineficaz en los recién nacidos. MÉTODO: Estudio de precisión diagnóstica de diseño transversal realizado en unidades de maternidad de medio y alto riesgo, localizada en la ciudad de Fortaleza-CE. Se evaluaron 216 recién nacidos para la identificación de las características definitorias del diagnóstico en estudio. Las medidas de precisión de las características definitorias se obtuvieron a partir de un modelo de 2 clases latentes con efectos aleatorios para el cálculo de los valores de sensibilidad y especificidad. RESULTADOS: Las características de frecuencia respiratoria aumentada y piel caliente al tacto presentaron valores de sensibilidad más altos (99,9%) y de especificidades menores (79 y 75%) y las características fluctuaciones de la temperatura corporal por encima y por debajo de los parámetros normales e hipertensión fueron las de mayor especificidad (80,4%) y sensibilidad (100%), respectivamente. CONCLUSIÓN: La característica fluctuación de la temperatura corporal por encima y por debajo de los parámetros normales puede ser más adecuadas para confirmar la presencia del diagnóstico, por haber presentado un mayor valor de especificidad

OBJECTIVE: To identify the measures of accuracy for defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns. METHOD: Diagnostic accuracy study with cross-sectional design performed in medium and high-risk maternity units, located in Fortaleza city/Brazil. A total of 216 newborns were evaluated to identify the defining characteristics of the diagnosis under study. The measures of accuracy for defining characteristics were obtained from a latent class model with random effects for the calculation of sensitivity and specificity values. RESULTS: The characteristics of increased respiratory rate and warm skin to the touch had higher sensitivity values (99.9%) and lower specificity (79 and 75%) and the characteristics of body temperature fluctuations above and below the normal parameters and hypertension had the highest specificity (80.4 and 100%, respectively). CONCLUSION: The characteristic fluctuation of the body temperature above and below the normal parameters may be better to confirm the diagnosis, having presented a higher specificity value

Mild Traumatic Brain Injury in the Emergency Department: A Clinical Practice Gap.

This article, "Concussion Care in the Emergency Department: A Prospective Observational Brief Report," by seeks to examine current clinician practice patterns related to the evaluation and management of patients identified as at risk for a sustained mild traumatic brain injury (mTBI). The findings are discussed in the context of an evaluation and management gap surrounding mTBI care among emergency department (ED) providers at a Level I trauma and emergency care center. Although variabilities exist among mTBI care in the ED, provider education, standardization of guidelines, and implementation practices are strategies for increasing the uptake of care in the ED for patients presenting with mTBI.

Middle-Range Theory for the Nursing Diagnosis of Low Self-Efficacy in Health.

OBJECTIVES: theoretical validation of the concept of low self-efficacy in health as a nursing diagnosis construct. METHODS: construction of a middle-range theory for validating diagnoses, comprised of five stages: definition of the approach for building the theory; definition of the main concepts; creation of a pictorial diagram; formulation of proposals; establishment of causal relationships and evidence for clinical practice. The main concepts were identified through a literature review and the studies were taken from the LILACS, SCOPUS, CINAHL and PubMed/MEDLINE databases. The final sample was comprised of 92 articles. RESULTS: eighteen etiological factors and 16 clinical indicators were identified; characterized as antecedents and manifestations for inferring a diagnosis of low self-efficacy in health. CONCLUSIONS: the related concepts of the new nursing diagnosis of low self-efficacy in health, to be applied in clinical nursing practice, were identified and defined.

Validation of interventions for risk of impaired skin integrity in adult and aged patients.

OBJECTIVES: to validate nursing interventions for the diagnosis Risk for Impaired Skin Integrity in adult and aged hospitalized patients. METHODS: descriptive, quantitative study, using the content validity of interventions done by 14 specialist nurses. RESULTS: the specialist nurses had worked in the area for more than five years. Four (28.5%) used NANDA-I and CIPE®, three (21.4%) used NANDA-I, NIC and CIPE®, three (21.4%) used NANDA-I, NIC, NOC and CIPE® and four (28.5%) were currently working only with CIPE®. The validation analyzed 32 NIC interventions, of which 11 were priority and 21 were suggested. Of the priority interventions, five belonged to the Physiological/Complex domain, five to the Physiological/Basic domain and one to the Safety Domain. FINAL CONSIDERATIONS: nursing interventions are essential for planning and support good practices in teaching, research and care.

Validation of the definitions of nursing diagnoses for individuals with Aids.

OBJECTIVES: to develop and validate conceptual and operational definitions of nursing diagnoses of the International Classification for Nursing Practice for people living with Aids. METHODS: methodological study with 100 individuals with Aids, in a hospital school. In addition, 19 nurses selected from the Lattes platform acted as experts in the validation process. The research was conducted, using three moments: identification and validation of the nursing diagnoses; construction of the conceptual and operational definitions of the diagnoses, and content validation, using the content validity index. RESULTS: a total of 35 diagnoses were identified and 18 had their conceptual and operational definitions validated, with validity index of ≥ 0.8. CONCLUSIONS: the construction of the conceptual and operational definitions enables nurses to analyze the clinical inferences and endorse the nursing diagnosis, contributing to its predictive capacity.

Clinical validation of the nursing diagnosis risk for suicide in the older adults.

OBJECTIVE: To clinically validate risk factors for the nursing diagnosis risk for suicide in older adults. METHODS: Case-control study (105 older adults). The strength of the association between variables was assessed using odds ratio (OR). Risk factors were grouped into hierarchical blocks according to the Integrated Motivational-Volitional Model of Suicidal Behaviour. RESULTS: Anxiety; guilt; divorce; hostility; inability to express feelings; loss of important relationship; financial problems; apathy; low self-esteem; hopelessness; dependence and functional incapacity; unhappiness; failure; frustration; marked change in attitude and behavior; sadness; self-neglect; stockpiling medication; depression; ideation and suicidal plans; and mental disorders were associated with risk for suicide. CONCLUSIONS: It is expected that this study will contribute to clinical nursing practice by the identification of this diagnosis in a safer and more precise manner. Descriptors: clinical judgment, nursing diagnosis, psychiatric nursing, suicide, older adult.

Early Recognition of Pediatric Sepsis Simulation Checklist - An Exploratory Study.

PURPOSE: To report on the modification and exploration of a 21-item Early Detection of Pediatric Sepsis Assessment Checklist aimed at improving nursing students' recognition of key factors that contribute to early detection of sepsis in pediatric patients through clinical simulation. DESIGN AND METHODS: One hundred and thirty-one undergraduate, pre-licensure nursing students were evaluated using the adapted 21-item Early Detection of Pediatric Sepsis Assessment Checklist in simulation using high-fidelity manikins. Categorical Principle Component Analysis was used to evaluate for factor structure, with items accounting for <0.20 of the variance were dropped from the loadings. RESULTS: Two factors emerged from the analysis: assessment and deterioration, accounting for 68% of the variance. Factor one, assessment, contained nine items (α = 0.77; λ = 3.36). Factor two, deterioration, contained seven items (α = 0.72; λ = 2.85). Five items did not load and were dropped from the factor structure, resulting in a 16-item checklist. CONCLUSIONS: Two factors emerged from the analysis which is key to improving the early detection of pediatric sepsis. Assessment, factor one, accounted for the nursing students' central skills of recognizing baseline vital signs and timely medication administration. Deterioration, factor two, contained items reflecting the recognition of changes from baseline that require action. Conceptually, these factors reflect the most central points in the early detection of signs in pediatric patients at risk for sepsis. PRACTICE IMPLICATIONS: This checklist forms a valuable tool to assess the knowledge of pre-licensure students and may possibly be extended as a tool to assess the clinical readiness and performance of new graduates through the safety and supervision allotted by simulation.

Validation of interventions for risk of impaired skin integrity in adult and aged patients / Validación de las intervenciones para los riesgos de integridad de la piel perjudicada en adultos y personas mayores / Validação de intervenções para risco de integridade da pele prejudicada em adultos e idosos

ABSTRACT Objectives: to validate nursing interventions for the diagnosis Risk for Impaired Skin Integrity in adult and aged hospitalized patients. Methods: descriptive, quantitative study, using the content validity of interventions done by 14 specialist nurses. Results: the specialist nurses had worked in the area for more than five years. Four (28.5%) used NANDA-I and CIPE®, three (21.4%) used NANDA-I, NIC and CIPE®, three (21.4%) used NANDA-I, NIC, NOC and CIPE® and four (28.5%) were currently working only with CIPE®. The validation analyzed 32 NIC interventions, of which 11 were priority and 21 were suggested. Of the priority interventions, five belonged to the Physiological/Complex domain, five to the Physiological/Basic domain and one to the Safety Domain. Final Considerations: nursing interventions are essential for planning and support good practices in teaching, research and care.

RESUMEN Objetivos: validar las intervenciones de enfermería para el diagnóstico riesgos de integridad de la piel perjudicada de pacientes adultos y personas mayores hospitalizadas. Métodos se trata de un estudio descriptivo, cuantitativo, realizado por 14 enfermeras especialistas que utilizaron la validez de contenido de intervención. Resultados: quedó en evidencia que las enfermeras especialistas trabajaban en el área hace más de cinco años. Se observó que cuatro (28.5%) utilizaban NANDA-I y CIPE®, tres (21.4%) NANDA-I, NIC y CIPE®, tres (21.4%) NANDA-I, NIC, NOC y CIPE® y cuatro (28.5%) trabajaban, por el momento, sólo con CIPE®. La validación analizó 32 intervenciones de NIC, siendo 11 prioritarias y 21 sugeridas. De las intervenciones prioritarias, cinco pertenecían al ámbito Fisiológico/Complejo, cinco al Fisiológico/Básico y una al de Seguridad. Consideraciones Finales: las intervenciones de enfermería son esenciales para planificar y conseguir subsidios que promuevan las buenas prácticas en la enseñanza, la investigación y la atención.

RESUMO Objetivos: validar as intervenções de enfermagem para diagnóstico Risco de integridade da pele prejudicada de pacientes adultos e idosos hospitalizados. Métodos: estudo descritivo, quantitativo, utilizando a validade de conteúdo de intervenção, por 14 enfermeiras especialistas. Resultados: evidenciou-se que os enfermeiros especialistas trabalhavam na área há mais de cinco anos. Observou-se que quatro (28,5%) utilizavam NANDA-I e CIPE®, três (21,4%) NANDA-I, NIC e CIPE®, três (21,4%) NANDA-I, NIC, NOC e CIPE® e quatro (28,5%) atualmente estavam trabalhando apenas com a CIPE®. A validação analisou 32 intervenções da NIC, sendo 11 prioritárias e 21 sugeridas. Das intervenções prioritárias, cinco pertenciam ao domínio Fisiológico/Complexo, cinco ao Fisiológico/Básico e uma ao de Segurança. Considerações Finais: as intervenções de enfermagem são essenciais para o planejamento, favorecendo subsídios para boas práticas no ensino, pesquisa e assistência.

Validation by experts of Risk of suicide Nursing Diagnosis in the elderly.

OBJECTIVE: to validate the conceptual and operational definitions content of factors for Risk of suicide Nursing Diagnosis in the elderly. METHOD: this is validation of the conceptual and operational definitions content of factors for Risk of suicide in the elderly, performed by 15 experts, from November 2015 to March 2016. Risk factors were classified into three hierarchical chuncks. The data were analyzed by descriptive statistics and binomial test. RESULTS: of the 54 validated risk factors, only eight presented problems regarding clarity, simplicity and accuracy: chronic pain, vision problems, retirement, frustration, medication neglect and depression. Only rigidity was not validated as relevant for the study diagnosis. CONCLUSION: content validation of the risk factors for Nursing Diagnosis can guide the clinical practice of the nurse in the early detection of risk of suicide in the elderly.

Clinical validation of nursing diagnosis "00085 Impaired Physical Mobility" in multiple traumas victims.

OBJECTIVE: to clinically validate the nursing diagnosis "Impaired Physical Mobility", identifying its prevalence, defining characteristics, related factors, and associated conditions with the calculation of accuracy measures and generation of Decision Trees, as well as clinically and etiologically characterize the multiple traumas victims. METHOD: methodological, cross-sectional study of clinical validation type, using diagnostic accuracy measures and generating decision tree. RESULTS: the sample consisted of 126 patients, 73% male, with a mean age of 38.29 years. The frequency of the nursing diagnosis studied was 88.10%; the defining characteristic with the highest prevalence was "Difficulty turning" (58.73%), with a predictive power of 98.6%; the associated condition "Alteration in bone structure integrity" stood out with 72.22%. The accuracy measures also indicated their predictive power. CONCLUSION: the components aforementioned were considered predictors of this diagnosis. This study contributed to improve the identification of clinical indicators associated with advanced methods of diagnostic validation, directing care and reducing the variability present in clinical situations.

Related factors of the nursing diagnosis ineffective breathing pattern in an intensive care unit. / Fatores preditores do diagnóstico de enfermagem padrão respiratório ineficaz em pacientes de uma unidade de terapia intensiva.

OBJECTIVE: to identify the predicting factors and sensitivity, specificity, positive and negative related value of nursing diagnosis Ineffective Breathing Pattern among patients of an intensive care unit. METHOD: cross-sectional study. A logistic regression was fitted to assess the simultaneous effects of related factors. RESULTS: among the 120 patients, 67.5% presented Ineffective Breathing Pattern. In the univariate analysis, the related factors were: group of diseases, fatigue, obesity and presence of bronchial secretion, and the defining characteristics were: changes in respiratory depth, auscultation with adventitious sounds, dyspnea, reduced vesicular murmurs, tachypnea, cough and use of the accessory musculature to breathe. The mean age of patients with was higher than those without this diagnosis. The defining characteristics reduced murmurs had high sensitivity (92.6%), specificity (97.4%), negative related value (86.4%) and positive related value (98.7%). The related factors of Ineffective Breathing Pattern were the related factors fatigue, age and group of diseases. CONCLUSION: fatigue, age and patients with a group of diseases were related factors of Ineffective Breathing Pattern in this study. Reduced vesicular murmurs, auscultation with adventitious sounds and cough may be defining characteristics to be added in the international classification, as well as the related factors bronchial secretion and group of diseases.

Clinical indicators of nursing outcomes classification for patient with risk for perioperative positioning injury: A cohort study.

AIMS AND OBJECTIVES: To test the validity and reliability of Nursing Outcomes Classification outcomes and their clinical indicators for patients with the nursing diagnosis 'Risk for perioperative positioning injury'. BACKGROUND: Surgical positioning is an essential part of perioperative nursing practice. The use of a standardised language values the clinical evaluation of the perioperative nurse, reinforcing its contribution to surgical patient care. DESIGN: Longitudinal concept validation cohort study. METHODS: Patients were selected based on the operating room surgical schedule. The sample included adult patients who underwent elective surgical procedures requiring anaesthesia, classified as surgical class 2, 3 or 4. Outcomes were measured with an instrument, which included 33 clinical indicators for eight outcomes. The patients were assessed at five distinct time points in the perioperative phases. This study followed the STROBE guidelines. RESULTS: A total of 50 patients were included. Each underwent five clinical assessments, for a total of 250 documented assessments. Differences in evaluations were mostly related to reduced scores of clinical indicators in the immediate postsurgical time points, which recovered to the highest score at the end of the fifth (and last) evaluation. The results of factor analysis and Cronbach's alpha calculations suggested a new configuration for this nursing outcomes, consisting of five outcomes-Circulation Status, Tissue Perfusion: peripheral, Neurological Status: peripheral, Tissue Integrity: skin and mucous membranes and Thermoregulation-and 13 clinical indicators. CONCLUSIONS: Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnosis at 'Risk for perioperative positioning injury' are sensitive to patient states during the perioperative period. RELEVANCE TO CLINICAL PRACTICE: Use of nursing taxonomies during the perioperative period may contribute to the discussion on the role of perioperative nurses and their relevance in patient care.