Operational definitions of outcome indicators related to ineffective breathing patterns in children with congenital heart disease

Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review

OBJECTIVE

To synthesize the outcomes reported in the rehabilitation and community literature for adults with traumatic lower limb amputation (LLA).

DATA SOURCES

The search strategy was conducted in 3 databases (Medline, EMBASE, and CINAHL) from inception to April 2022.

STUDY SELECTION

To be eligible, articles could be of any design but were required to have at least 50% adult individuals with traumatic LLA and had to report on interventions and outcomes in either a rehabilitation or community setting.

DATA EXTRACTION

The extracted outcomes were classified using Dodd's framework, which is designed for organizing research outcomes. Heterogeneity was observed in the outcome measures (OMs) used for evaluation. Two reviewers independently conducted the data extraction, which was verified by a third reviewer.

DATA SYNTHESIS

Of the 7,834 articles screened, 47 articles reporting data on 692 individuals with traumatic LLA, met our inclusion criteria. Four core areas encompassing 355 OMs/indicators were identified: life effect (63.4%), physiological/clinical (30.1%), resource use (5.1%), and adverse events (1.4%). Physical functioning (eg, gait, mobility) was the most frequently reported outcome domain across studies, followed by nervous system outcomes (eg, pain) and psychiatric outcomes (eg, depression, anxiety). Domains such as global quality of life and role/emotional functioning were seldomly reported.

CONCLUSION

The study provides a list of outcome indicators explicitly published for adults with traumatic LLA, highlighting inconsistent reporting of outcome indicators. The lack of a standardized set of OMs is a barrier to performing meta-analyses on interventions, preventing the identification of effective care models and clinical pathways. Developing a core outcome set that includes OMs relevant to the needs of the traumatic LLA population may address these issues.

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.

Development and Validation of the Operational Definitions of the Defining Characteristics of the Nursing Diagnosis of Insomnia in the Occupational Health Setting

PURPOSE

To develop and validate the operational definition (ODs) for each defining characteristic (DC) contained in the Nursing Diagnosis (ND) "insomnia" (00095) in the occupational health context.

METHODS

Methodological study carried out in two stages, including a consensus of experts to develop the ODs (Stage 1) and an online Delphi panel, performed in two rounds, to validate them (Stage 2).

FINDINGS

The 15 ODs proposed in Stage 1 were narrowed down to six validated ODs in the first round (diagnostic content validity index [DCVI] = 0.80-0.89). In the second round, five ODs were validated (DCVI = 0.80-0.94). Finally, the remaining four ODs were validated by the general consensus of experts.

CONCLUSIONS

The ODs were validated, although there remains some doubt as to whether some of the DCs can be applied to the field of occupational health.

IMPLICATIONS FOR NURSING PRACTICE

The ODs developed and validated could improve the diagnostic accuracy of the ND "insomnia" (00095) in the context of occupational health.

Conceptual and operational definition of nursing outcomes regarding the breastfeeding establishment

OBJECTIVE

to construct conceptual and operational definitions of Nursing Outcomes "Breastfeeding establishment: infant (1000)" and "Breastfeeding establishment: maternal (1001)".

METHOD

integrative literature review in the following databases: PUBMED (United States National Library of Medicine); LILACS (Latin American and Caribbean Health Sciences Literature); CINAHL (Cumulative Index to Nursing and Allied Health Literature); SciVerse SCOPUS; Web of Science; BDENF (Brazilian Nursing Database) and EMBASE (Excerpta Medica Database). The gray literature was explored to elucidate topics not covered by the articles. Of 3242 articles, 96 were selected to be read in full, and 43 were used for constructing the definitions. Five theses, three dissertations, three books and two manuals were selected.

RESULTS

all the results were reviewed. The definitions facilitated the improvement of the content proposed by the Nursing Outcomes Classification, favoring its application in clinical practice and supporting the development of research and teaching.

CONCLUSION

it was proposed to change the definition of the two outcomes, as well as to change the title of one of them to "Breastfeeding establishment: newborn & infant" (1000), modifying seven of its indicators and excluding one. For the outcome related to the mother, it was proposed to modify two indicators and exclude one.

Conceptual and operational definitions for the indicators of the nursing outcome classification: Symptom control in patients with heart failure in palliative care

OBJECTIVE

To validate conceptual and operational definitions of Symptom control (1608) indicators for patients with cardiac diseases in palliative care.

METHOD

Definitions were established through a literature review and were validated by consensus among expert nurses. Two rounds of the Delphi method and a meeting with experts were carried out in order to validate the definitions for the indicators and for the magnitude of response for each indicator.

RESULTS

Conceptual and operational definitions for Symptom control (1608) indicators and for the magnitude of response for each indicator were validated.

CONCLUSIONS

All conceptual and operational definitions of 11 indicators of the nursing outcome Symptom control (1608) were validated by experts. Content and clinical validation studies remain necessary to verify the capacity of the indicators to measure the effectiveness of nursing interventions in clinical practice and research.

Psychometric Assessment of the Nursing Outcome Swallowing Status: Rasch Model Approach

PURPOSE

To apply the Rasch model to test the psychometric assessment of the nursing outcome Swallowing status among poststroke patients.

METHODS

Cross-sectional study was conducted with 227 poststroke patients, which were evaluated by a nurse. The Rasch model was used to examine psychometric properties.

FINDINGS

Indicators fit the Rasch model and presented good reliability and good ability for separation index. The 5-point Likert scale did not present adequate discrimination and classification levels were compiled into three.

CONCLUSIONS

Data evidenced the use of a robust method to perform a clinical validity of the Swallowing status, complementing previous validation studies.

RELEVANCE TO CLINICAL PRACTICE

Using Rasch analysis serve as reference points to assess Swallowing status on a single scale.

OBJETIVO

Aplicar o modelo Rasch para testar as medidas psicométricas do resultado de enfermagem Estado da deglutição em pacientes acometidos por acidente vascular cerebral. MÉTODOS: Estudo transversal, realizado com 227 pacientes após AVC avaliados por um único enfermeiro. O modelo Rasch foi usado para examinar propriedades psicométricas.

RESULTADOS

Os indicadores se ajustaram ao modelo Rasch e apresentam boa confiabilidade e boa capacidade de separação. A escala Likert de 5 pontos não apresentou discriminação adequada e os níveis de classificação foram compilados em três pontos. CONCLUSÃO: Os dados evidenciaram o uso de um método robusto para a validade clínica do Estado da deglutição, complementando os estudos de validação anteriores. RELEVÂNCIA PARA A PRÁTICA CLÍNICA: O uso do modelo Rasch serve como ponto de referência para avaliar o Estado da deglutição em uma única escala.

Clinical validation of fall prevention behavior in a hospital environment

ABSTRACT Objective: Clinically validate the Nursing Outcome Behavior of falls prevention in hospitalized patients. Method: This was a cross-sectional study developed at a public university hospital with a sample of 45 patients. The data collection was performed through the evaluation of four nurses, with a double used the instrument with the constitutive and operational definitions of the indicators and magnitudes of the Fall Prevention Behavior Result, while the other pair did not use such definitions. Results: When applying the non-parametric analysis of variance by the Friedman test, ten indicators showed statistical differences between the inferences made by the evaluators for each patient. In relation to the intraclass correlation coefficient, confidence interval and p value assigned to each indicator of the scale, most of the indicators were statistically significant. Conclusions: The instrument referring to the Fall Behavior Outcome Behavior was considered valid for the study population.

Clinical Indicators for Evaluation of Outcomes of Impaired Tissue Integrity in Orthopedic Patients: Consensus Study

PURPOSE

To select outcomes from the Nursing Outcomes Classification (NOC) to evaluate impaired tissue integrity in patients undergoing orthopedic surgeries, and develop conceptual and operational definitions for their indicators.

METHODS

A consensus study involving 10 nurses from clinical practice. A 100% consensus was established in the outcomes selection.

FINDINGS

Wound Healing: Primary intention (1102) with two indicators: (110214) Scar formation, and (110201) Skin approximation were selected. Four indicators were grouped to evaluate inflammatory signs together with foul wound odor and six for drainage.

CONCLUSIONS

These indicators direct the outcomes evaluation for wound healing.

IMPLICATIONS FOR NURSING PRACTICE

Support to the definition the priority interventions in nursing process documentation.

Respiratory status of adult patients in the postoperative period of thoracic or upper abdominal surgeries

Objective:

to evaluate the respiratory status of postoperative adult patients by assessing the nursing outcome Respiratory Status.

Method:

descriptive, cross-sectional study developed with 312 patients. Eighteen NOC indicators were assessed and rated using a Likert-scale questionnaire and definitions. Descriptive and correlative analysis were conducted.

Results:

the most compromised clinical indicators were coughing (65.5%), auscultated breath sounds (55%), and respiratory rate (51.3%). Factors associated with worse NOC ratings in specific clinical indicators were sex, age, pain, and general anesthesia.

Conclusions:

certain clinical indicators of respiratory status were more compromised than others in postoperative patients. Patient and context-related variables can affect the level of respiratory compromise.

Validação das características definidoras do diagnóstico de enfermagem conforto prejudicado em oncologia

Resumo Objetivo Validar o conteúdo das características definidoras do diagnóstico de enfermagem conforto prejudicado, proposto pela NANDA-I, em pacientes sob cuidados paliativos em oncologia. Métodos Estudo metodológico, segundo o modelo de validação de conteúdo diagnóstico de Fehring, numa amostra de 53 enfermeiros peritos. Realizado o teste de Mann-Whitney e o coeficiente de correlação de Spearman (p-valor <0,05) para verificar se houve influências no julgamento dos peritos. Resultado Validou-se o conteúdo de dezessete características definidoras, do diagnóstico de enfermagem em questão, e mais outras sete características definidoras elaboradas no presente estudo. Nove características definidoras foram consideradas maiores, outras doze foram consideradas menores e três excluídas. O escore total do diagnóstico foi 0,74. Conclusão Validar o conteúdo das características definidoras do diagnóstico de enfermagem Conforto Prejudicado para pacientes em cuidados paliativos na oncologia é uma maneira de alicerçar a prática clínica do enfermeiro em conhecimentos teóricos próprios da profissão.

Clinical Differentiation of Respiratory Nursing Diagnoses among Children with Acute Respiratory Infection

The aim of this study was to identify the defining characteristics that allow clinical differentiation of the nursing diagnoses, ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE). A secondary analysis with a cohort design was developed from 1128 records obtained during the hospital stay of 136 children with acute respiratory infection. Groups of defining characteristics with greater differentiation capacity were identified by multiple correspondence analyses. The results showed that the defining characteristics that better differentiate the studied diagnoses are agitation, irritability and diaphoresis for IGE; dyspnea, use of accessory muscles to breathe, orthopnea, and abnormal breathing pattern for IBP and excessive sputum, absence of cough, difficulty verbalizing, nasal flaring, and adventitious breath sounds for IAC. Twelve defining characteristics that can assist clinicians to differentiate the three main respiratory nursing diagnoses among children with acute respiratory infection were identified in this study.

Validação clínica do resultado de enfermagem mobilidade em pacientes com acidente vascular cerebral

RESUMO Objetivo Validar clinicamente o resultado de enfermagem Mobilidade em pacientes com acidente vascular cerebral. Métodos Estudo descritivo, desenvolvido em julho de 2011 com 38 pacientes em tratamento ambulatorial, no nordeste do Brasil. A coleta de dados aconteceu por meio da avaliação de duas duplas de enfermeiras especialistas, sendo que uma dupla utilizou o instrumento contendo as definições constitutivas e operacionais dos indicadores e magnitudes do Resultado Mobilidade e a outra dupla sem tais definições. Resultados Ao analisar as avaliações entre as enfermeiras, todos os indicadores apresentaram diferença significativa pelo teste de Friedman (p<0,05). Conclusão As definições constitutivas e operacionais submetidas ao processo de validação proporcionam maior acurácia na avaliação do estado de Mobilidade do paciente com acidente vascular cerebral.

Knowledge produced from the outcomes of the "Nursing Outcomes Classification - NOC": integrative review

Objective: To identify the knowledge produced from the outcomes of the Nursing Outcomes Classification (NOC). Method: A literature review using the integrative databases: Latin American and Caribbean Health Sciences (LILACS), US National Library of Medicine (PubMed), Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Scopus Info Site (SCOPUS), during the months of August and September 2014. Results: The review consisted of 21 articles that addressed different issues: Translation and Cultural adaptation (4.77%); Applicability in clinical practice (33.33%); and, Validation (63.90%). Analysis of these articles showed that the knowledge produced from the Nursing Outcomes Classification includes translation and cultural adaptation, evaluation of applicability and validation of its items. Conclusion: Considering the continuous evolution of this classification, periodic reviews should be carried out to identify the knowledge, use and effects of the NOC.

Acurácia na inferência de diagnósticos de enfermagem de pacientes com insuficiência cardíaca

RESUMO Insuficiência cardíaca (IC) é causa frequente de internação exigindo do enfermeiro precisão na conduta clínica e adequado julgamento dos diagnósticos de enfermagem. Objetivo: verificar acurácia na determinação dos diagnósticos de enfermagem fadiga, intolerância à atividade e débito cardíaco diminuído em paciente com IC hospitalizados. Método: estudo descritivo aplicado aos enfermeiros experientes em diagnósticos de enfermagem NANDA-I e/ou IC. Avaliação da acurácia foi realizada a partir do cálculo das medidas: eficácia (E), falso negativo (FN), falso positivo (FP) e tendência (T). Foram aptos os enfermeiros com inspeção aceitável para dois diagnósticos. Resultados: o diagnóstico de enfermagem fadiga foi o mais erroneamente identificado pelos enfermeiros avaliadores. Discussão: a busca pelo aperfeiçoamento da acurácia diagnóstica reafirma a necessidade de treinamento contínuo e específico para a melhora da capacidade diagnosticadora do enfermeiro. Conclusão: o treinamento permitiu o exercício do raciocínio clínico e melhor acurácia dos enfermeiros.

Construction and validation of indicators and respective definitions for the nursing outcome Swallowing Status

OBJECTIVE

to develop indicators for the nursing outcome Swallowing Status and the respective conceptual and operational definitions validated by experts and in a clinical setting among patients after having experienced a stroke.

METHOD

methodological study with concept analysis and content and clinical validations. The Content Validation Index was verified for the scores assigned by 11 experts to indicators. Two pairs of nurses assessed 81 patients during the clinical validation: one pair used an instrument with definitions and the other used an instrument without definitions. The resulting assessments were compared using Intraclass Correlation Coefficient, Friedman's test, and Minimal Important Difference calculation.

RESULTS

All the indicators, with the exception of the indicator Ability to bring food to mouth, presented Content Validation Index above 0.80. The pair using the instrument with definitions presented an Intraclass Correlation Coefficient above 0.80 for all the indicators and similarity was found in all the assessments, according to the Minimal Important Difference calculation. The pair using the instrument without definitions presented a low coefficient (ρ<0.75) for all the indicators.

CONCLUSION

the results showed that greater uniformity and accuracy was achieved by the pair of nurses using the conceptual and operational definitions for the indicators of the nursing outcome Swallowing Status.

Defining the key clinical indicators for ineffective breathing pattern in paediatric patients: a meta-analysis of accuracy studies

AIMS AND OBJECTIVES

The purpose of this study was to identify the key clinical indicators of ineffective breathing pattern among paediatric patients.

BACKGROUND

When nurses perform clinical reasoning, certain characteristics represent the clinical indicators necessary to confirm the presence of a particular diagnosis. Some quantitative studies have reported the prevalence of ineffective breathing pattern in different samples of patients. However, these findings should be synthesised.

DESIGN

Meta-analysis of quantitative nursing studies.

METHODS

Studies were identified via systematic searches of CINAHL, LILACS, PubMed and Scopus using the key search terms 'ineffective', 'breathing' and 'pattern'. Additional quality-related inclusion criteria were gleaned from the Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy, the Standards for Reporting of Diagnostic Accuracy and the Quality Assessment of Diagnostic Accuracy Studies. The pertinent results from each study were extracted and analysed via meta-analysis.

RESULTS

Six studies using paediatric populations met the inclusion criteria. Summary measures indicated that the following defining characteristics had the highest accuracy values for ineffective breathing pattern among children: bradypnoea, dyspnoea, nasal flaring, orthopnoea, tachypnoea and the use of accessory muscles to breathe.

CONCLUSION

This meta-analysis provides information regarding the accuracy of the clinical indicators of ineffective breathing pattern from studies sampling diverse paediatric populations.

RELEVANCE TO CLINICAL PRACTICE

Nurses can better use clinical indicators to infer the presence of ineffective breathing pattern when they are aware of the most relevant defining characteristics. Nursing students and professionals can also improve their critical thinking abilities and diagnostic reasoning based on these findings.

Clinical applicability of nursing outcomes in the evolution of orthopedic patients with Impaired Physical Mobility

AIM

to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility

METHOD

longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed.

RESULTS

The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035).

CONCLUSION

the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.

[Nursing outcomes for ineffective breathing patterns and impaired spontaneous ventilation in intensive care]

This study aimed to validate the results of Nursing selected from the link NANDA-I-NOC (Nursing Outcomes Classification--NANDA--International) for diagnosis Ineffective Breathing Pattern and Impaired Spontaneous Ventilation in adult intensive care unit. This is a content validation study conducted in a university hospital in southern Brazil with 15 expert nurses with clinical experience and knowledge of the ratings. The instruments contained five-point Likert scales to rate the importance of each outcome (1st step) and indicator (Step 2) for the diagnoses studied. We calculated weighted averages for each outcome/indicator, considering) 1 = 0. 2 = 0.25, 3 = 0.50 4 = 0.75 and 5 = 1. The outcomes suggested by the NOC with averages above 0.8 were considered validated as well as the indicators. The results Respiratory State--airway permeability (Ineffective Breathing Patterns) and 11 indicators, and Response to mechanical ventilation: adult (Impaired Spontaneous Ventilation) with 26 indicators were validated.

Validation of indicators of the nursing outcomes classification for hospitalized adults at risk of infection

This study aimed to validate the indicators of the Nursing Outcomes proposed by the Nursing Outcomes Classification for the diagnosis Risk of Infection. Content validation was performed according to 12 nurse experts from the clinical, surgical and intensive care units of a university hospital. The analysis was based on the weighted arithmetic average of the scores the experts assigned to each indicator assessed and scores that reached at least 0.80 were validated. Out of 132 proposed indicators, 67 were validated for eight nursing outcomes described for the diagnosis Risk of Infection, which had been validated in a previous study. The content validation process identified that the Nursing Outcomes Classification presents feasible results and indicators to evaluate and identify the best care practices. This study will support the implementation of the Nursing Outcomes Classification in clinical practice, teaching and research.

Conceptual validation of the defining characteristics of respiratory nursing diagnoses in neonates

OBJECTIVE: To develop and validate conceptual and operational definitions for the defining characteristics of the respiratory nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation, in newborns.METHODS: This was a methodological study of conceptual validation of the defining characteristics of three respiratory nursing diagnoses, by consensus analysis of a committee of five specialist nurses, and then a group of five non-nursing professionals, using the Delphi technique.RESULTS: After two rounds of evaluation, consensus was obtained that was equal to or greater than 80% on all of the definitions, which were then considered validated.CONCLUSION: The definitions developed for the defining characteristics of three nursing diagnoses were validated with a high level of consensus.

Intervention for ineffective airway clearance in asthmatic children: a controlled and randomized clinical trial

This study aimed to analyse the effectiveness of an intervention for the nursing diagnosis of ineffective airway clearance in asthmatic children. A blinded, randomized and controlled clinical trial was developed in a paediatric hospital located on northeast of Brazil with 42 asthmatic children aged ≤ 36 months. The children were randomly divided into two groups (intervention and control) by means of a simple drawing. The applied intervention included actions related to change of positioning and stimulation of cough. The main findings of this study show that before the intervention, no significant difference was observed in the health status of the children. After the intervention, the indicators of choking (16.83 vs. 26.17, P = 0.007) and adventitious breath sounds (16.4 vs. 26.6, P = 0.005) were higher, on average, in the intervention group. It was observed an improvement in obstructive symptoms in children who received the intervention proposed.