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.

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.

Impaired knowledge in individuals with heart failure: a middle range nursing theory

OBJECTIVE

To develop a middle range nursing theory of impaired knowledge in individuals with heart failure.

METHODS

Descriptive study of the cross type developed through the theoretical-causal validity method, which used six steps for theory building: Definition of the construction approach; Definition of theoretical-conceptual models; Definition of main concepts; Development of a pictorial scheme; Construction of propositions; and Establishment of causal relations and evidence for practice.

RESULTS

Twenty-four articles were found, which identified two attributes, eight antecedents, and seven consequences, which gave rise to the pictogram, which schematized the concepts by relating them to cardiac physiology. Finally, 11 propositions and four causal relationships were created.

CONCLUSION

The constructed theory enables a targeted driving of nurses' clinical judgment regarding impaired knowledge in individuals with heart failure, culminating in individualized interventions to improve quality of life.