Deficient knowledge in patients with heart failure: A study of diagnostic accuracy and etiological relationships

PURPOSE

To evaluate the accuracy of defining characteristics and causal relationships of the etiological factors of the nursing diagnosis deficient knowledge in individuals with heart failure .

DATA SOURCES

An analytical, cross-sectional study on the diagnostic accuracy of the defining characteristics and causal relationships of the etiological factors of the nursing diagnosis. The sample consisted of 140 patients with chronic HF and in outpatient follow-up. The latent class analysis method was used to test the accuracy of measurements and estimate the prevalence of the diagnosis. The calculation of subsequent probabilities and the odds ratio ( were also parameters employed. The study was approved by the Research Ethics Committee of the Federal University of Pernambuco.

DATA SYNTHESIS

The diagnosis had an estimated prevalence of 38.57% in the sample. The inaccurate statements about the disease and/or therapy, self-care deficient performance, and inadequate behavior were the clinical indicators that best predicted the presence of the diagnosis and demonstrated the same sensitivity value (1.0000), specificity (1.0000), and 95% confidence interval (0.9999-1.0000) for all. The populations at risk was elderly (OR = 2.12, confidence interval 95% = 1.05-4.27), and illiterate individuals (OR = 2.07, confidence interval 95% = 1.03-4.16) had an approximately twofold great chance of developing havening deficient knowledge.

CONCLUSION

The evaluation of the accuracy of clinical indicators, corresponding to the defining characteristics in the study, contributed to screening and diagnostic establishment capacity in clinical practice, and to the translation of theoretical and practical knowledge.

IMPLICATIONS FOR NURSING PRACTICE

Accurate clinical indicators of the nursing diagnosis deficient knowledge facilitate the clinical reasoning of nurses and favor the professional's role in the development of health education strategies focused on the acquisition of knowledge about the disease by patients, family members, and caregivers.

Accuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients

OBJECTIVES

to analyze the accuracy of the clinical indicators of ineffective airway clearance in adult intensive care unit patients.

METHODS

diagnostic accuracy study, performed in the intensive care unit of a university hospital in northeastern Brazil. The sample consisted of 104 patients hospitalized between June and October 2019.

RESULTS

the prevalence of ineffective airway clearance was 36.54%. The indicators with high specificity included absence of cough (0.8326), orthopnea (0.6817), adventitious breath sounds (0.8175), and diminished breath sounds (0.8326). The clinical indicators with high sensitivity and specificity were alteration in respiratory rate (0.9999) and alteration in respiratory pattern (0.9999).

CONCLUSIONS

six clinical indicators provided an accurate identification of ineffective airway clearance. The clinical indicators alteration in respiratory rate and alteration in respiratory pattern were the most accurate for critical adult patients. The findings of this study contribute to accurate diagnostic inferences and to prevention of respiratory complications in these patients.

Analysis of the content of the nursing diagnosis deficient knowledge in individuals with heart failure

OBJECTIVE

To analyze the content of the nursing diagnosis deficient knowledge in individuals with heart failure.

METHODS

Methodological study to validate the content of a nursing diagnosis based on the predictive model of diversity, carried out through the organization of the phenomenon of interest and analysis by judges using the collective wisdom model. The NANDA-I Knowledge Deficient diagnosis was evaluated by 48 judges and considered valid when it presented a median content validity index ≥ 0.8 in the confidence intervals.

RESULTS

Note that 66.6% of the judges indicated that the new definition proposed was more adequate than the definition adopted by NANDA-I. After the experts' analysis, the following defining characteristics were considered valid: inaccurate statements about the disease and/or therapy, inadequate performance in the management of intercurrences, increase in hospital readmissions, worsened quality of life, deficit in self-care performance, and follow-up of inadequate instruction; related factors are as follows: inadequate guidance offered by health professionals, nonparticipation of the patient in the planning of their health care, weakened relationship between professional and individual; populations at risk-elderly and low level of education of the individual and/or caregiver and the associated condition, mild cognitive impairment. Anxiety, depression, and impaired social interaction were elements considered not relevant to the content domain.

CONCLUSION

The validation of the content of the aforementioned diagnosis in patients with heart failure, through the analysis of judges with different degrees of expertise, made it possible to improve the definition and expansion of new diagnostic indicators.

IMPLICATIONS FOR NURSING PRACTICE

Updated diagnostic elements for the nursing diagnosis deficient knowledge in individuals with heart failure will facilitate accurate clinical judgment and the establishment of a therapeutic plan aimed at etiological factors modifiable by nurses.

Accuracy of risk factors for nursing diagnosis risk of infection in people with AIDS

OBJECTIVE

To evaluate the accuracy of risk factors for infection that add up to the nursing diagnosis risk of infection in people with AIDS who are hospitalized.

METHOD

Accuracy study with case-control design carried out with a total of 208 people living with AIDS and hospitalized between 2010 and 2016. The cases comprised people living with HIV, hospitalized and who developed infection related to health care and controls to those who did not develop it. Secondary data from medical records and research forms were used to respond to the data collection instrument for sociodemographic, clinical evaluation and investigation of the presence or absence of risk factors. The accuracy of clinical diagnostic indicators was measured through specificity, sensitivity and predictive values.

RESULTS

The risk factor that showed the greatest sensitivity and specificity was chronic illness, while the invasive procedure and the change in the integrity of the skin had the highest positive predictive value.

CONCLUSION

Accurate diagnoses allow nurses to build a nursing intervention plan aimed at the needs of this population.

[Analysis of the concept of the Zika Virus congenital syndrome]

The scope of this article is to analyze the concept of the Zika Virus Congenital Syndrome. It is a conceptual analysis, based on Walker and Avant. In order to operationalize the search, a systematic review was conducted. The essence of the concept of the Zika Virus Congenital Syndrome is determined by the following attributes: intracranial calcification, ventriculomegaly, and diminished brain volume. For this syndrome to occur, it is necessary to have the following antecedents: transplacental transmission of a mother infected by the bite of the Aedes SSP mosquito or by sexual contact. Accordingly, this entails a set of signs and symptoms that go beyond fetal or postnatal microcephaly, such as, for example, delayed neuropsychomotor development, auditory and visual abnormalities, craniofacial disproportion, overlapping cranial sutures, prominent occipital bone, excess nuchal skin, epilepsy, irritability, dyskinesia, hypertonia, hypotonia, hemiplegia, hemiparesis, spasticity and hyperreflexia. The concept of the Zika Virus Congenital Syndrome is newly acknowledged. The presence of the set of signs and symptoms by the Zika Virus Congenital Syndrome is determined by intracranial calcification and decreased brain volume, and the baby may present microcephaly at birth or subsequently.