Content Validation of Parental Role Conflict in the Neonatal Intensive Care Unit

PURPOSE. To validate the content of the nursing diagnosis parental role conflict made by neonatal intensive care (NICU) nurses and researchers in the field and to identify the related major and minor defining characteristics.METHOD. Fehring's Diagnostic Content Validation model using 59 neonatal specialists.FINDINGS. Nineteen defining characteristics were validated for use in NICUs: four were considered major and 15 as minor. There was no correlation between nurse profiles and defining characteristic scores.CONCLUSIONS. In this study, parental role conflict was validated for use in neonatal units but defining characteristics must be described in a clearer and more objective manner.NURSING IMPLICATIONS. Validation studies in different healthcare settings are required so that the specificities of each clientele are met. NANDA diagnoses must be tested and validated at neonatal units, because this setting has developed few studies and their use in practice is a potential way to improve nursing care.     

Validation of the Defining Characteristics of the Nursing Diagnosis Ineffective Airway Clearance

The investigators designed this validation study to determine the defining characteristics of the nursing diagnosis ineffective airway clearance. Using Fehring's Diagnostic Content Validity Model, 546 nurses who care for respiratory clients validated one major and 19 minor defining characteristics. Nine characteristics previously described in the literature were eliminated. Clarification of the defining characteristics of this diagnosis improves communication in practice, education and research.     

Predictive factors of the nursing diagnosis sedentary lifestyle in people with high blood pressure

ABSTRACT Objectives: To verify the reproducibility of defining the characteristics and related factors in order to identify a sedentary lifestyle in patients with high blood pressure. Design and Sample: A cross‐sectional study. 310 patients diagnosed with high blood pressure. Measures: Socio‐demographics and variables related to defining the characteristics and related factors of a sedentary lifestyle. The coefficient Kappa was utilized to analyze the reproducibility. The sensitivity, specificity, and predictive value of the defining characteristics were also analyzed. Logistic regression was applied in the analysis of possible predictors. Results: The defining characteristic with the greatest sensitivity was demonstrates physical deconditioning (98.92%). The characteristics chooses a daily routine lacking physical exercise and verbalizes preference for activities low in physical activity presented higher values of specificity (99.21% and 95.97%, respectively). Conclusions: The following indicators were identified as powerful predictors (85.2%) for the identification of a sedentary lifestyle: demonstrates physical deconditioning, verbalizes preference for activities low in physical activity, and lack of training for accomplishment of physical exercise.     

Stress Incontinence: Clinical Identification and Validation of Defining Characteristics

Stress incontinence as a valid nursing diagnosis has remained clinically untested since its approval as a nursing diagnosis in 1986. No defining characteristics of stress incontinence have been clinically identified or validated. The Stress Urge Incontinence Instrument was developed to assist nurses to differentiate between two nursing diagnoses: stress incontinence and urge incontinence. Findings from two clinical studies validate the presence of stress incontinence in a population of community-dwelling older women and provide an initial list of clinically identified and validated defining characteristics present in women with the confirmed medical diagnosis of stress incontinence.     

Validation of Increased Intracranial Pressure and High Risk for Increased Intracranial Pressure

The authors designed this validation study to determine the defining characteristics of increased intracranial pressure and the risk factors for high risk for increased intracranial pressure. Using Fehring's Diagnostic Content Validity Model, a purposive sample of 219 nurses validated 17 major and 16 minor defining characteristics of increased intracranial pressure and nine major and six minor risk factors for high risk for increased intracranial pressure. Ratings were similar among nurses with diverse educational preparation but varied among nurses in different specialty areas, suggesting that practice setting is important in nursing diagnosis validation studies.     

Altered level of consciousness: validity of a nursing diagnosis

The purpose of this three-phase study was to examine the validity of the nursing diagnosis altered level of consciousness (ALC). The conceptual framework was diagnostic reasoning. In Phase I, 26 content experts certified in neuroscience nursing completed four rounds of a Delphi survey to identify defining characteristics and operational definitions for the nursing diagnosis. The diagnosis was divided into ALC: arousal and ALC: content. In Phase II, 30 staff nurses from two neuroscience intensive care units (NICUs) used the magnitude estimation scaling technique in judging the importance and frequency of occurrence of defining characteristics chosen in Phase I. In Phase III, 60 patients in two NICUs were assessed for frequency of occurrence of the defining characteristics for ALC: arousal and ALC: content. In Phase I, there was greater than or equal to 70% agreement on the appropriateness and clarity of 28 and 24 defining characteristics and operational definitions for ALC: arousal and ALC: content, respectively. In Phase II, there were 7 major defining characteristics identified for ALC: arousal and 6 major defining characteristics identified for ALC: content. In Phase III, there were 13 defining characteristics that occurred with significantly greater frequency in patients with an ALC: arousal and 17 defining characteristics that occurred with significantly greater frequency in patients with an ALC: content.     

A Multivariate Validation of the Defining Characteristics of Fatigue

PURPOSE. To validate the nursing diagnosis fatigue by providing evidence to identify, confirm, and consolidate the defining characteristics.
METHODS. The Revised Piper Fatigue Scale and the Schwartz Measurement of Fatigue scales were used to collect data from four groups of healthy women (N = 182). Data were analyzed by maximum-likelihood factor analysis with varimax rotation, and major and minor defining characteristics were identified and clustered.
FINDINGS. The identified defining characteristics tended to group into the dimensions identified in prior fatigue studies. Although the majority of the NANDA defining characteristics were validated, differences were found.
CONCLUSIONS. atigue is a multidimensional construct. Replication of the study with a variety of samples from different geographic locations and a variety of patient populations will further cross-validate the defining characteristics of fatigue.
PRACTICE IMPLICATIONS. Fatigue is a commonly experienced phenomenon in both health and illness. As the knowledge base about fatigue builds, so will the accuracy of nursing assessments and the effectiveness of nursing interventions.     

Rapid and validated fluorometric HPLC method for determination of gabapentin in human plasma and urine for clinical application

What is known and Objective: A rapid derivatization and validated HPLC method for gabapentin in human plasma and urine is needed for clinical use. The objective of this study was to establish a rapid and validated analytical method for the determination of gabapentin in human plasma and urine using isocratic fluorometric HPLC for clinical application. Methods: This analytical method is based on precolumn fluorescent derivatization using 4‐fluoro‐7‐nitro‐benzofurazan. The derivatization was coupled to fast HPLC separation using a 2·3 μm‐particle size ODS column (100 × 4·6 mm i.d.). Results and Discussion: The derivatization of gabapentin was optimized and HPLC separation was achieved over an ODS column with a run time of 3·5 min. Calibration curves in human plasma and urine were linear over the concentration ranges of 0·05–10 and 10–1000 μg/mL, respectively. Intra‐ and inter‐assay precision and accuracy values of plasma were within 8·0% and 101–109% and within 8·3% and 94–108%, respectively. Those of urine were within 8·5% and 97–106% and within 9·5% and 97–105%, respectively. This validated method was applied to a pharmacokinetic study in healthy subjects. Interindividual variations in plasma disposition and urinary excretion of gabapentin were observed. What is new and Conclusion: A rapid and validated isocratic fluorometric HPLC method for the determination of gabapentin in human plasma and urine for clinical application has been established. This method can be utilized to evaluate the pharmacokinetic disposition of gabapentin in humans.     

Nursing diagnoses: a study of cultural relevance.

This study examines the adequacy/inadequacy of three nursing diagnoses with cultural etiologies: (1) impaired verbal communication related to cultural differences; (2) impaired social interaction related to sociocultural dissonance; and (3) noncompliance related to patient value system. The research tool was administered to the membership of the American Nurses Association Council on Cultural Diversity and the International Transcultural Nursing Society, with a response rate of N = 245 (42.2 per cent) from 43 states, the District of Columbia, and seven foreign countries. The tool listed the North American Nursing Diagnosis Association (NANDA) defining characteristics and cultural etiology for each diagnosis rated on a five-point Likert scale from "nearly always present" to "rarely present." The subjects also wrote and ranked other defining characteristics they used to make the diagnosis in clinical practice. Percentage distribution results indicate no defining characteristic meets the NANDA criteria for a major or minor defining characteristic. By collapsing categories, seven were acceptable only as minor defining characteristics. Respondents' 113 suggestions for additional characteristics were content analyzed. Themes for 12 categories were intuited and added to the lists. Based on respondents' suggestions, the definitions for each diagnosis were reworked, and new cultural-related factors were added. The cultural adequacy/inadequacy of elements within these three diagnoses was identified and provides the opportunity for greater selectivity in their clinical use. Additional suggestions from transcultural nursing experts form a data base for future research to expand the use of the currently limited components of NANDA diagnoses with culturally diverse patients.     

Feeding Dysfunction: A Nursing Diagnosis for Infants Who Resist Oral Feeding

This paper reports a project that identified and validated a nursing diagnosis for the problem of ineffective infant feeding behaviors—feeding dysfunction. Three validation phases were used for development of the diagnosis. During the first phase the literature review provided information about the problem, the etiologies, and the defining characteristics. Phase two of the validation process utilized nurse specialists who were surveyed for their expert judgment of the etiologies and defining characteristics. The third validation phase used case studies of several infants together with assessment of the infants' feeding abilities to validate further the etiologies and defining characteristics. Support for the diagnosis infant feeding dysfunction was evident.     

Variations in percentage of body fat within different BMI groups in young,middle-aged and old women

Objectives: The objective of the present study was to characterize age‐dependent variations in percentage of body fat within different body mass index (BMI) classes in healthy Danish women. Design: Cross‐sectional analysis. Settings: The study was done at the Center for Clinical and Basic Research, Ballerup, Denmark. Subjects: Four hundred and four healthy women aged 18–75 years were included in the present study. Measurements: Fat tissue mass was estimated using dual‐energy X‐ray absorptiometry. Menopausal status and physical characteristics were also registered. Results: Mean values of percentage of body fat calculated in the normal and overweight BMI groups were higher in middle‐aged and old women compared with young women. No significant differences were seen in the underweight and obese BMI groups. The cut‐off levels between normal and overweight and between overweight and obesity were 35–43% and 40–50%, respectively. Conclusion: The percentage of body fat is dependent on both age and menopausal status within each of the following BMI classes: from 20 to 25 and from 25 to 30, further emphasizing that BMI has limitations when used generally as an indicator of body fatness, and argues for defining BMI cut‐off values age‐specifically.     

Clinical Validation of Characteristics of the Alcoholic Family

PURPOSES. To validate, from a client and family perspective, the defining characteristics for the nursing diagnosis altered family processes: alcoholism; and to identify demographic, family, and selected treatment information from clients and family members.
METHODS. Subjects (N = 150) completed Fehring's (1987) Clinical Diagnostic Validation (CVD) Index for 110 defining characteristics of the nursing diagnosis altered family processes: alcoholism.
FINDINGS. Alcoholic families display behaviors of alcohol abuse, loss of control of drinking, denial, nicotine addiction, impaired communication, inappropriate expression of anger, and enabling behaviors. Family feelings indicate the presence of unhappiness, hurt, frustration, guilt, moodiness, powerlessness, loneliness, mistrust, anger, anxiety, and hopelessness.
CONCLUSIONS. These clinically validated characteristics will complete the assessment phase of this research and direct the path to future studies to determine appropriate goals/outcomes and interventions related to alcoholic families.     

Activity Intolerance and Impaired Physical Mobility in Elders

PURPOSE: To clarify the use of two nursing diagnoses, activity intolerance and impaired physical mobility, with elderly patients. METHOD: Ninety-two elders from a long-term care facility in Wonju, Korea. A checklist developed by the researchers was used for data collection. FINDINGS: Defining characteristics from this study related to psychological components of activity intolerance are significant in differentiating between the two diagnoses. Using a decision-making tree based on data from this study, each nursing diagnosis can be correctly identified. CONCLUSIONS: The results of this study are significant in broadening the defining characteristics to be used in differentiating between two nursing diagnoses. PRACTICE IMPLICATIONS: Clarification of nursing diagnoses serves to direct students and nurses to choosing appropriate interventions.     

Using nursing practice guidelines for the prevention of multidrug‐resistant tuberculosis among hospitalized adult patients in Bangladesh

Multidrug‐resistant tuberculosis (MDR‐TB) is one of the major public health concerns worldwide particularly in developing countries, including Bangladesh. Thus far, there are no well‐validated clinical guidelines for the prevention of MDR‐TB. This study aims to evaluate the improvement in nurses' practice using the newly developed Nursing Practice Guidelines for the Prevention of MDR‐TB (NPG: MDR‐TB) among hospitalized adult patients in Bangladesh. The guidelines were developed, disseminated and evaluated among 64 nurses by assessing nursing practice for the prevention of MDR‐TB during pre‐ and postimplementation of the guidelines. Significant differences between pretest and post‐test mean scores of nursing practice for the prevention of MDR‐TB in case finding and case holding were found in three levels of wards, including Level 0 (non‐TB), Level 1 (TB) and Level 2 (MDR‐TB) (P < 0.001). This indicated that the guidelines might be applicable to reduce the development of MDR‐TB in hospitals. However, this was a preliminary study with a limited time frame. Further evaluation is, therefore, needed.     

Mental Health Nurses as therapists in a rehabilitation setting: A phenomenological study

Mental Health Nurses have a long tradition of delivering talk‐based interventions across a range of clinical settings. Despite this, Mental Health Nurses receive limited recognition of this contribution. This paper presents findings from a study that explored Mental Health Nurses' experience of delivering talk‐based therapies in an inpatient rehabilitation setting. This study uses semistructured interviews and a phenomenological approach to explore eight Mental Health Nurses' experience. Themes emerging included that: mental health nursing is a talk‐based therapy in its own right, talk‐based therapy was part of everyday nursing care on the floor and integrated talk‐based therapy enhanced recovery opportunities for consumers. However, a further theme was that there were tensions around providing talk‐based therapy conflicted with other roles including unit management and the role of nurses in controlling challenging behaviours. This study found that Mental Health Nurses, in this setting, are offering talk‐based therapy to the people they care for. The findings of this study have implications for research: there needs to be a larger study investigating nurses' use of talk‐based therapy in inpatient settings. If, as the authors expect that, it is found that mental health nurses are offering these therapies generally in inpatient settings, this has serious implications for postgraduate education in Mental Health Nursing policy in terms of recognition that this is happening and finding ways to support nurses to do this well. There also needs to be further research in the best ways to offer talk‐based therapy in these settings.