Clinical Validation of Nursing Diagnoses of Acute Pain in Hospitalized Children

PURPOSE. Clinically validate (Fehring's model) the characteristics of the nursing diagnosis acute pain in 65 hospitalized children. METHODS. Cross‐sectional study. FINDINGS. This study resulted in 13 major characteristics (expressive behavior, change of mental state, verbal report of pain, observed evidence of pain, narrowed focus, position to avoid pain, guarding behavior, sleep disturbance, protective gestures, changes in heart rate, changes in muscle tone, changes in respiratory rate, and facial mask) and in 5 minor characteristics (changes in blood pressure, coded report, changes in breathing pattern, distraction behavior, and changes in appetite). CONCLUSIONS. Characteristics with R > 0.50 and ≤ 1 were valid in the diagnosis acute pain. IMPLICATIONS FOR NURSING PRACTICE. Clinical validation studies must be reproduced in different populations. OBJETIVO. Validar clinicamente as características definidoras do Diagnostico de Enfermagem (DE) Dor Aguda, em sessenta e cinco crianças hospitalizadas, seguindo o modelo proposto por Fehring. MÉTODOS. Estudo transversal. RESULTADOS. Esse estudo resultou em 13 características definidoras maiores (Comportamento expressivo, Mudança do estado mental, Relato verbal, Evidência observada de dor, Foco em si próprio, Gestos protetores, Posição para evitar dor, Distúrbio do sono, Comportamento de proteção, Mudança na frequência cardíaca, Alteração no tônus muscular, Mudança na frequência respiratória e Expressão facial e cinco menores (Alterações na pressão sanguinea, relato codificado, alterações no padrão respiratório, Comportamento de Distração e Alterações no apetite). CONCLUSÕES. As CD com R > 0.50 e ≤ 1 foram validadas para o DE Dor Aguda. IMPLICAÇÕES PARA A PRÁTICA CLÍNICA. Estudos de validação clínica devem ser testados em outras populações.     

A Validation Study of the Nursing Diagnosis Anxiety in Brazil

PURPOSE.  This study aims to validate the nursing diagnosis of anxiety among expert Brazilian nurses and clinicians using NANDA International defining characteristics and to compare the clinical judgments of the experts and the clinicians.
METHOD.  A semistructured questionnaire was completed by a convenience sample of 120 nurses. NANDA International defining characteristics of the Brazilian Portuguese version were used. The analysis of the ratings was based on the framework of the Diagnostic Content Validation model. Brazilian nurses considered the anxiety definition established by NANDA International to be appropriate and experts' and clinicians' judgments were similar for both groups of nurses.
FINDINGS.  The results showed that among the 71 characteristics of anxiety, 8 were identified as critical defining characteristics of anxiety (score  ≥  0, 80) by the expert nurses.
CONCLUSIONS.  Brazilian nurses accepted the NANDA International definition for nursing diagnosis of anxiety although some defining characteristics might differ due to cultural differences. Future research could address the limitations of the study and examine validations by both the experts and the clinicians.
IMPLICATIONS FOR NURSING PRACTICE.  The adequate preparation of undergraduate and postgraduate nurses in nursing diagnosis is important in improving the quality of care given to patients.     

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.     

A Validation Study Using the Case-Control Method of the Nursing Diagnosis High Risk for Aspiration

PURPOSE. To develop further the nursing diagnosis risk for aspiration by determining risk factors present in patients who aspirated.
METHODS. The case-control design was used to compare cases (n = 131) and controls (n = 206) on past and present exposures thought to be risk factors for aspiration. Data were analyzed using univariate and multiple logistic regression.
FINDINGS. The following risk factors were statistically significant and comprise the final model: altered level of consciousness, metoclopramide ( known to accelerate gastric emptying), vomiting, seizures, and unable to change own position.
CONCLUSIONS. The risk factors of altered level of consciousness and delayed gastric emptying are currently included in the NANDA taxonomy for the nursing diagnosis risk for aspiration. These risk factors are not included in the taxonomy: vomiting, seizures, and unable to change own position. Results of the study have been submitted to the Diagnosis Review Committee for consideration to further develop this diagnosis.     

Validation Study for Impaired Personal Boundaries, Proposed Nursing Diagnosis

The authors propose a new nursing diagnosis of impaired personal boundaries based on their experience in psychiatric nursing, a concept analysis of the literature and diagnostic content validation by a panel of experts. Impaired personal boundaries are common in a number of mental disorders including, schizophrenia, borderline personality, substance abuse and enabling. Recognition of this patient problem has implications for further research and nursing interventions.