Nursing Diagnosis and Depressive Illness

In nursing practice, clinicians have identified specific nursing diagnoses that repeatedly emerge in depressed individuals. Specifically, chronic low self-esteem, powerlessness, and hopelessness have been linked with depressive illness and reflect Beck's cognitive theory of depression, which postulates that depressive symptoms result from a negative view of self, world, and future. The purpose of this analysis was to validate defining characteristics of three nursing diagnoses while evaluating the usefulness of the Cognitive Triad Index for specifying critical and supporting indicators for these nursing diagnoses in a population of 63 depressed adult inpatients. A patient-focused clinical diagnostic validation model was used. Results are discussed in light of previously specified defining characteristics for these diagnoses and directions for future research related to clinical validation of these diagnoses are recommended.     

Content Validation of Impaired Skin Integrity and Urinary Incontinence in the Home Health Setting

The purpose of this study was to examine content validity of two nursing diagnoses in the home health setting: impaired skin integrity and altered urinary elimination: total incontinence. Eighty-two home health nurses rated the importance of each of the defining characteristics for the two nursing diagnoses. Diagnostic content validity scores (DCV) were calculated for each defining characteristic for both diagnoses using the method described by Fehring (1986). Four characteristics for each diagnosis had DCV scores greater than .75, indicating characteristics were critical indicators for the diagnosis. Erythema, denuded skin, disruptions of dermal and epidermal tissue, and lesions were critical indicators for impaired skin integrity. Lack of awareness of incontinence, constant flow of urine, lack of awareness of bladder cues to void, and incontinence refractory to other treatments were critical indicators for alteration in urinary elimination: total incontinence.     

The need for operational definitions for defining characteristics.

Although much attention has focused on the validation of defining characteristics for nursing diagnoses, equal attention has not been devoted to the development of operational definitions for defining characteristics. Operational definitions, however, provide a reference for determining whether defining characteristics are present in patients who participate in clinical validation studies. Validation of nursing diagnoses emerges from occurrence of the diagnostic label in clinical practice. Operational definitions provide the bridge between incidental observation and scientific validation of nursing diagnoses.     

The Expert Nurse Profile and Diagnostic Content Validity of Sedentary Lifestyle: The Spanish Validation

PURPOSE: To identify the diagnostic content validity of Sedentary Lifestyle and to identify the expert nurse profile in validating this nursing diagnosis in the Spanish cultural context. METHODS: Fehring's Diagnostic Content Validity (DCV), the factorial validity of the defining characteristics, the analysis of convergent validity, and the expert profile were assessed. FINDINGS: The DCV index for experts was .70. The factorial validity showed two different factors: the expression of laziness and the performance of activities of daily living. On the expert profile related factors analysis, two factors, experience and education, were identified. CONCLUSIONS: The DCV for Sedentary Lifestyle was high among the expert nurses. A nurse was considered to be an expert who was able to accurately answer the four labels identified as nursing diagnoses, had read at least one nursing process article in the past year, and was able to list three nursing process reference books. IMPLICATIONS FOR PRACTICE: Clarifying the manifestations of sedentary lifestyle will assist clinical nurses in determining this diagnosis, and the expert profiles will assist in the selection of participants for content validity studies.     

Clinical referents for nursing diagnoses.

Validation of nursing diagnoses is an essential step in developing knowledge for nursing practice and should be a major goal of the discipline. Nursing diagnoses must have clinical referents, that is, defining characteristics which appear in patient populations exhibiting specific nursing diagnoses. Selecting nursing diagnoses for patient populations, developing a list of defining characteristics and operational definitions for a nursing diagnosis, selecting a standard to discriminate among subjects and constructing an instrument to document the occurrence of defining characteristics in selected patient populations are preliminary steps in identifying clinical referents. Methodological concerns addressed in establishing clinical referents for nursing diagnoses included controlling confounding factors, determining sample size, conducting a pilot study, determining interrater reliability, selecting appropriate statistical tests, and identifying critical defining characteristics for a nursing diagnosis.     

The Need for Operational Definitions for Defining Characteristics

Although much attention has focused on the validation of denning characteristics for nursing diagnoses, equal attention has not been devoted to the development of operational definitions for defining characteristics. Operational definitions, however, provide a reference for determining whether defining characteristics are present in patients who participate in clinical validation studies. Validation of nursing diagnoses emerges from occurrence of the diagnostic label in clinical practice. Operational definitions provide the bridge between incidental observation and scientific validation of nursing diagnoses.     

Cues for nursing diagnosis of ineffective self-management of fluid and dietary restrictions in dialysis therapy in Japan

PURPOSE. We aimed to identify the cues of expert nurses and validate the cue information on the defining characteristics for a nursing diagnosis of ineffective self‐management of fluid and dietary restrictions in dialysis therapy in Japan. METHODS. We used qualitative interviews and two‐round Delphi studies. FINDINGS. The expert nurses regarded four signs of unmaintained fluid and dietary restrictions as major defining characteristics and nine other cues as minor defining characteristics. CONCLUSIONS. Expert nurses in dialysis therapy regard symptoms of health behavior as major cues for nursing diagnosis of ineffective self‐management of fluid and dietary restrictions in dialysis therapy. IMPLICATIONS FOR NURSING PRACTICE. Verification of the clinical validity and development of a specific, clinically useful database on nursing diagnoses are required.     

The implementation of nursing diagnoses. The Iowa Veterans Home experience

This article has reviewed the process of implementing nursing diagnoses in one long-term care agency. Nursing diagnoses improved nursing process skills, made problem identification more accurate, and aided the identification of nursing interventions and desired outcomes. Nursing diagnoses have become the organizing framework for quality assurance, staff development, specialization and consultation, and computer applications. The presence of a professional model of nursing practice facilitated the use of nursing diagnoses. Prior to implementing nursing diagnoses, IVH nurses had defined the scope of nursing practice and formed a committee structure for decision-making by all RNs. The structure included mechanisms for collective and individual accountability. All nurses participated in the decision to use nursing diagnoses in their practice. Each nurse had the opportunity to influence the process of change. The process of implementing nursing diagnoses at IVH continues. Nurses recognize the need to establish the validity of each diagnostic statement. Skill with the diagnostic process is expected to improve. Nurses also recognize the need to test interventions for specific diagnoses. The standard nomenclature will continue to be used for the improvement of nursing practice and for nursing department programming. The use of nursing diagnoses is the basis of the continued development of a professional model of nursing practice.     

Nursing diagnoses in an oncology population.

The purposes of this study are to identify the nursing diagnoses occurring in an oncology population, to validate these using the clinical validation model, and to determine whether clusters of defining characteristics and etiologies occurred among the diagnoses identified. Secondary analysis was conducted using the patient care records of 48 oncology patients. Twenty-five nursing diagnoses were identified. The most common diagnoses were alteration in comfort (pain) and alteration in nutrition (less than body requirements). The etiologies of stress, pain, life changes, disease, and treatment occurred in some combination in 14 diagnoses. The defining characteristics of pain and fatigue/weakness occurred in over six diagnoses. Clusters of defining characteristics occurred with eight diagnoses. Clusters of etiologies occurred with the diagnosis of sleep/rest disturbance. Validation of defining characteristics and etiologies indicated variation from those proposed by the North American Nursing Diagnosis Association. One overriding variation was in the degree of specificity of defining characteristics used in clinical practice. The findings of this study support the need for continued validation of nursing diagnoses and continued education of nurses in the use of nursing diagnoses. The findings also contribute to the body of knowledge in nursing diagnoses in oncology patients, and contribute to the work beginning to be done in the field of nursing diagnosis with research into the existence of clusters of defining characteristics, etiologies, and/or nursing diagnoses.     

Validation of defining characteristics: retrospective design

The American Association of Neuroscience Nurses (AANN) has accepted the concept of nursing diagnosis as one component of a general nursing framework which is designed to direct and evaluate the care of individuals with neuroscience dysfunction. Continuing development of nursing diagnosis as a conceptual basis for neuroscience practice is dependent upon several factors, one of which is research-based identification and validation of defining characteristics associated with nursing diagnoses commonly used in the care of patients with neurologic dysfunction. Defining characteristics are observable signs and symptoms present in the person with the problem. Identification and validation of defining characteristics are essential to the continued development and use of nursing diagnosis in nursing practice. Without clear, specific defining characteristics, neuroscience nurses are unable to effectively assess patients for the signs and symptoms necessary to formulate nursing diagnoses, monitor patient status or evaluate nursing interventions. One way to validate defining characteristics is the use of retrospective design.     

Validation of the Defining Characteristics of Body Image Disturbance in Japan

PURPOSE. To examine the validity of the nursing diagnosis body image disturbance and to specify its major and minor defining characteristics in Japanese culture.
METHODS. A qualified sample of 149 RNs with an average of 10 years of clinical experience and knowledge of nursing diagnosis was given a questionnaire consisting of 21 defining characteristics from NANDA, 8 additional items from the literature, and 2 distracting characteristics.
FINDINGS. Four major diagnostic content validation (DCV) scores of 0.75 and higher and 15 minor defining characteristics with DCV scores from 0.60 to 0.74 were identified.
CONCLUSIONS. This study provides a foundation for further study of culturally appropriate defining characteristics for use in Japan.     

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.     

Validation of defining characteristics: clinical design

In order to formulate accurate nursing diagnoses, neuroscience nurses must determine clinical validity of defining characteristics. Physiologic, psychologic, behavioral or social signs and symptoms may be studied. This article suggests methods to be used in validating defining characteristics including practical and research design considerations.     

Nursing Diagnoses in Patients With Leukemia

PURPOSE. To identify and describe nursing diagnoses, their related factors, and defining characteristics, in hospitalized leukemia patients and to categorize these nursing diagnoses within Functional Health Patterns.
METHODS. Content analysis of 15 nursing records and interviews with 7 oncology nurses working on a hematology/oncology ward in a University hospital in Maastricht, the Netherlands.
FINDINGS. In the leukemia population, 47 nursing diagnoses with their associated characteristics were identified and classified within 10 Functional Health Patterns. Most of the nursing diagnoses were related to the Nutritional-Metabolic, the Cognitive-Perceptual, Activity-Exercise, the Role-Relationship, and the Coping-Stress-Tolerance patterns.
CONCLUSIONS. Results describe the nursing care needs of patients with leukemia. Since the study used a small sample, results should be interpreted with caution. Further research is recommended.     

Validating the nursing diagnosis of impaired physical mobility

The lack of research-based literature and of research models for validating nursing diagnoses results in some ambiguity in research efforts. Research must, however, move forward if there is to be progress in differentiating nursing and medical diagnostic models and use of nursing diagnoses to improve communication among nurses. Operational definitions of nursing diagnosis terminology are essential to continue work in validating nursing diagnoses, particularly in the clinical setting. The diagnosis impaired physical mobility was found to be an appropriate diagnosis for rehabilitation patients. Continued study and refinement of etiologies and defining characteristics is needed.