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- Validation of nursing diagnoses - The Differential Diagnostic Validation Model as a strategyPublication . Caldeira, Sílvia Maria Alves; Chaves, Érika de Cássia Lopes; Carvalho, Emília Campos de; Vieira, Margarida Maria da SilvaObjective: to analyze the contribution and limits of the use of Richard Fehring’s differential diagnostic validation model, as a methodological strategy in the validation of diagnoses. Method: theoretical review about the differential diagnostic validation model for the validation of NANDA-I nursing diagnoses. Results: the nursing diagnosis constitutes the step that precedes and promotes the appropriate nursing intervention. The correct identification of the diagnosis is fundamental for effective interventions.The presentation of a structured classification of diagnoses, such as for example the taxonomy II of NANDA-I, facilitates the clinical judgment of the nurse. It is necessary that the diagnoses are clear and that the defining characteristics are specific, and the validation studies contribute to this objective. Conclusions: the differential diagnostic validation model permits the validation of differences between diagnoses with very similar meanings; however, it is little known and applied in the validation studies. It is a methodology that can be useful for the accuracy of diagnoses and for contribution to the current discussion of taxonomy II and its new proposals. Descriptors: nursing; nursing diagnosis; validation studies. RESUMO Objetivo: analisar a contribuição e limites no uso do modelo diferencial de diagnósticos de Richard Fehring, como estratégia metodológica na validação de diagnósticos. Método: revisão teórica sobre o modelo diferencial para a validação de diagnósticos de enfermagem da NANDA-I. Resultados: o diagnóstico de enfermagem constitui a etapa que precede e favorece a intervenção adequada do enfermeiro. A identificação correta do diagnóstico é fundamental para que as intervenções sejam eficazes. A apresentação sistematizada dos diagnósticos em classificações, como por exemplo a taxonomia II da NANDA-I, facilita o julgamento clínico do enfermeiro. É necessário que os diagnósticos sejam claros e que suas características definidoras sejam específicas, e os estudos de validação contribuem para esse objetivo. Conclusão: o modelo de validação diferencial permite validar as diferenças entre diagnósticos com significados muito semelhantes; contudo, está pouco divulgado e aplicado nos estudos de validação. É uma metodologia que pode ser útil para a acurácia dos diagnósticos e para a contribuição na discussão atual da taxonomia II e suas novas propostas. Descritores: enfermagem; diagnóstico de enfermagem; estudos de validação. RESUMEN Objetivo: analizar la contribución y límites en el uso del modelo diferencial de diagnósticos de Richard Fehring, como estrategia metodológica en la validación de los diagnósticos. Metodología: revisión teórica sobre el modelo diferencial para validación de diagnósticos de enfermería de NANDA-I. Resultados: el diagnóstico enfermero es la etapa que precede y promueve la adecuada intervención de la enfermera. La identificación de un diagnóstico correcto es fundamental para que las intervenciones sean de clasificación efectiva. La presentación estructurada de diagnósticos, tales como la taxonomía II de NANDA-I, facilita el juicio clínico de las enfermeras. Se espera que los diagnósticos sean claros y que sus características definitorias sean especificas y son los estudios de validación que contribuyen a este objetivo. Conclusiones: el modelo diferencial de validación de diagnóstico se utiliza para validar el diagnóstico diferencial con las diferencias entre los significados muy similares, sin embargo, es poco conocido y aplicado en los estudios de validación. Se trata de una metodología que puede ser útil para la exactitud del diagnóstico y por su contribución actual a la discusión de la II taxonomía y sus nuevas propuestas.Parte superior do formulario. Descriptores: diagnósticos de enfermería; enfermería; estudios de validación.
- Nursing diagnosis of ‘‘spiritual distress’’ in women with breast cancer prevalence and major defining characteristicsPublication . Caldeira, Sílvia; Timmins, Fiona; Carvalho, Emília de; Vieira, MargaridaBackground: Spirituality and spiritual needs of cancer patients are frequently mentioned in the nursing literature, but the most significant defining characteristics of spiritual distress in the context of clinical reasoning and nursing diagnosis are rarely explored. Understanding of these is important for effective spiritual intervention. Objective: The aim of this study was to identify the prevalence and the defining characteristics of the nursing diagnosis ‘‘spiritual distress,’’ as classified according to NANDA International, among women with breast cancer. Methods: This was a quantitative and cross-sectional study, comprising the third phase of a larger study investigating the clinical validation of spiritual distress in cancer patients undergoing chemotherapy. Fehring’s clinical diagnostic validation model was used to identify the prevalence and the major defining characteristics of the diagnosis. A convenience sample was used, and data were collected by structured interview. Results: A total of 70 women participated; most were married (62.9%) and had a mean age of 54 years, and 55.7% reported having at least 1 person depending on them. The average length of time since the cancer diagnosis was 30.9 months. Twenty-seven participants were experiencing spiritual distress (38.6%). Eleven defining characteristics were classified as major. Conclusions: The prevalence of spiritual distress and the major defining characteristics give clinical evidence about the nurse’s role in providing spiritual care. The results are useful for the improved use of the NANDA International diagnoses within this domain. Implications for Practice: The findings highlight the importance of assessing the defining characteristics of the diagnosis as an objective strategy to improve clinical reasoning related to spirituality and to facilitate more effective interventions.
- Spiritual distress: proposing a new definition and defining characteristicsPublication . Caldeira, Sílvia; Carvalho, Emília Campos; Vieira, MargaridaObjective To identify the definition and defining characteristics (DCs) of spiritual distress (00066). Method Integrative literature review. Results Thirty-seven articles and 35 DCs were identified. Spiritual distress as a response to health problems in the context of nursing care is different from an impaired ability to experience and integrate meaning in life. Conclusions The diagnosis misses some DCs that emerged from the literature review and lacks comprehensiveness. The domain and the class are reductionist toward its meaning. The taxonomy lacks a spiritual domain to include this and other diagnoses currently dispersed in other domains. Implications for Practice Further content and clinical validation is needed, as well as an assessment, to determine the diagnosis' class and domain.
- Clinical validation of the nursing diagnosis spiritual distress in cancer patients undergoing chemotherapyPublication . Caldeira, Sílvia; Timmins, Fiona; Carvalho, Emília Campos de; Vieira, MargaridaObjective: Validate the nursing diagnosis spiritual distress in cancer patients. Methods: Cross-sectional approach using Richard Fehring's Clinical Diagnostic Validity Model. Findings: The prevalence of diagnosis was 40.8% in a sample of 170 patients. A total of 16 defining characteristics were validated. Expresses suffering had the highest sensitivity value and lack of meaning in life had the highest specificity value. Conclusions: The diagnosis was validated. Cancer patients in spiritual distress are in a state of suffering related to lack of meaning in life. Implications for Practice: Sensitive diagnosis tools and language are required for nurses to make accurate judgments in situations of spiritual distress. Validation in different contexts would increase the clinical evidence of this diagnosis.
- The adequacy of the Q methodology for clinical validation of nursing diagnoses related to subjective FociPublication . Miguel, Susana; Caldeira, Sílvia; Vieira, MargaridaOBJECTIVE: This article describes the adequacy of the Q methodology as a new option for the validation of nursing diagnoses related to subjective foci. METHODS: Discussion paper about the characteristics of the Q methodology. FINDINGS: This method has been used in nursing research particularly related to subjective concepts and includes both a quantitative and qualitative dimension. CONCLUSIONS: The Q methodology seems to be an adequate and innovative method for the clinical validation of nursing diagnoses. IMPLICATIONS FOR PRACTICE: The validation of nursing diagnoses related to subjective foci using the Q methodology could improve the level of evidence and provide nurses with clinical indicators for clinical reasoning and for the planning of effective interventions.
- The nursing diagnosis ‘impaired walking’ in elderly: systematic literature reviewPublication . Marques-Vieira, Cristina Maria Alves; Sousa, Luís Manuel Mota de; Sousa, Lisete Maria Ribeiro de; Caldeira, SílviaWalk is an activity that requires different skills and can be highly complex particularly for the elderly. The aim was to identify the defined characteristics and related factors of the nursing diagnosis impaired walking in elderly. A Systematic literature review, based on a search done between January and March 2014, in the electronic platforms EBSCO Host®, SCOPUS and ISI, and using the search strategy walk* OR gait AND Nurs*. A sample of 36 studies was obtained. A total of 17 defined characteristics and 34 related factors were identified. Among all, nine defined characteristics and 20 related factors are not listed in the diagnosis of NANDA International. This research identified new defined characteristics and related factors not listed in NANDA International. This study is a contribution to the development of the taxonomy of NANDA International, which should represent nursing knowledge, and this highlights some implications for clinical practice, education and further research.
- Validação do diagnóstico de enfermagem angústia espiritualPublication . Berenguer, Sílvia Maria Alves Caldeira; Vieira, Margarida Maria da Silva; Carvalho, Emília Campos deIntrodução: Os diagnósticos de enfermagem constituem um julgamento clínico acerca das respostas humanas aos processos de vida e de saúde, enquadrado em domínios do conhecimento e das competências dos enfermeiros. A identificação de diagnósticos de natureza espiritual é dificultada pela subjetividade e complexidade do conceito de espiritualidade, não obstante os doentes sentirem necessidades espirituais. O diagnóstico de enfermagem angústia espiritual integra a NANDA-I desde 1978 e tem sido submetido a estudos de validação, com escassez de validação clínica que contribua para a melhoria do seu baixo nível de evidência. Objetivos: Realizar a validação de conteúdo e a validação clínica do diagnóstico de enfermagem angústia espiritual da NANDA-I; identificar a prevalência do diagnóstico na amostra de doentes com cancro submetidos a quimioterapia; conhecer a sensibilidade, especificidade e valor preditivo das características definidoras do diagnóstico. Metodologia: A validação baseou-se nos modelos de Richard Fehring. Decorreu entre fevereiro de 2011 e abril de 2012, em três fases distintas. A primeira fase consistiu na revisão integrativa de literatura acerca do conceito e dos indicadores clínicos de angústia espiritual. Na segunda realizou-se a validação de conteúdo com enfermeiros peritos portugueses e decorreu em simultâneo com a terceira fase, de validação clínica, através de entrevista a doentes com cancro submetidos a quimioterapia. Os doentes foram entrevistados para preenchimento de um formulário que, além das características definidoras, incluia três critérios de identificação do diagnóstico: a opinião do doente, o diagnóstico pela investigadora e um questionário de bemestar espiritual. Resultados: Da revisão integrativa de literatura obtivemos uma amostra de 37 artigos entre os quais foram identificados 10 estudos de validação e, entre estes, um estudo de validação clínica. Identificámos 35 indicadores clínicos de angústia espiritual. Foi realizada uma comparação semântica entre estes resultados e os da NANDA-I por investigadores em espiritualidade, da qual resultaram 40 indicadores para validação. Desta revisão resultou uma proposta de uma nova definição para o diagnóstico. Na fase de validação de conteúdo obtevese uma amostra de 42 peritos, dos quais 41 concordaram com a nova proposta para a definição do diagnóstico. Além da classe três do domínio 10, os peritos sugeriram outras classificações para o diagnóstico. Todas as características foram validadas: 18 principais e 22 secundárias. Na terceira fase, obtivémos uma amostra de 170 doentes. O doente típico foi do sexo feminino, católico, com 56,2 anos, com o diagnóstico há 24 meses e em tratamento há 15 meses. A prevalência de angústia espiritual foi de 40,8%. Foram validadas 16 características definidoras. As 12 características classificadas como principais obtiveram valores significativos de sensibilidade e de valor preditivo para o diagnóstico, sendo que 7 destas características não estão classificadas na NANDA-I, porque emergiram da primeira fase do estudo. A característica definidora mais sensível foi expressa sofrimento e a característica definidora mais específica foi falta de sentido na vida. Conclusões: O diagnóstico de enfermagem angústia espiritual da NANDA-I requer revisão da classificação a nível de domínio, classe, definição e características definidoras. A prevalência do diagnóstico confirma que os enfermeiros encontrarão doentes em angústia espiritual e necessitam reunir competências para intervenções adequadas. A validação clínica em outros contextos é fundamental no intuito de acrescentar mais evidência àquela reunida neste estudo e demonstrou ser um método que permite conhecer as características definidoras e o diagnóstico com maior precisão. Outros estudos de validação clínica contribuirão para o desenvolvimento da taxonomia e para a prática clínica, porquanto oferecem ao enfermeiro dados para a definição de diagnósticos num processo de cuidados que se espera eficaz e eficiente
- The contribution of the Rasch Model to the clinical validation of nursing diagnoses: integrative literature reviewPublication . Oliveira-Kumakura, Ana Railka de Souza; Caldeira, Sílvia; Simão, Talita Prado; Camargo-Figuera, Fábio Alberto; Cruz, Diná de Almeida Lopes Monteiro da; Carvalho, Emília Campos dePURPOSE: To analyze the knowledge related to the use of the Rasch model in validation of nursing diagnoses. METHODS: Integrative literature review with search in LILACS, PUBMED, CINAHL, and SCOPUS. FINDINGS: Five studies comprised the sample, which analyzed unidimensionality, local independence, item calibration, item reliability, separation of items and people, and differential item functioning for analyzing nursing diagnoses. CONCLUSIONS: The Rasch model seems to be a useful method to validate nursing diagnoses and probably also for the validation of nursing outcomes in the Nursing Outcomes Classification. The use of this model is promising, considering the advan- tages that it can be used in studies with several methodological designs. IMPLICATIONS FOR NURSING: Methods that are able to provide more robust evidence of nursing diagnosis validity are needed to support highly accurate diag- nostic findings in clinical practice.
- The human responses and nursing diagnoses of head and neck cancer patients: literature review and synthesis of evidencePublication . Miguel, Susana; Zamarioli, Cristina Mara; Carvalho, Emília Campos de; Caldeira, SílviaIntroduction: Head and neck cancer is relatively common with a high morbidity rate due to the anatomical sites that surround and may result in psychosocial, physical, or functional effects. Knowledge about the human responses and the corresponding nursing diagnoses of head and neck cancer patients undergoing surgery, as listed on NANDA-I, seems scarce. Aim: Review the literature on knowledge about the human responses and the corresponding nursing diagnoses of head and neck cancer patients undergoing surgery. Materials and Methods: Integrative literature review with a search on electronic databases: CINALH®, MEDLINE®, Nursing & Allied Health®, and Scopus®. Results: A total of 31 papers were included in this review and 72 human responses, categorized in 29 diagnoses. Most diagnoses are subjective, and the most frequent nursing diagnosis was disturbed body image. Conclusion: Identifying the most frequent human responses of these patients facilitates nurses in providing adequate care and in developing further research aiming to improve diagnoses accuracy. Most diagnoses are subjective, and the clinical validation could improve the level of evidence and provide nurses with clinical indicators for clinical reasoning and effective planning and interventions. Particularly, differential validation is needed in these patients as similar diagnoses and confounding clinical indicators have been identified. Further research is needed to evaluate the subjective nursing diagnoses considering the similarity and specific defining characteristics in head and neck cancer.
- Risk for falls among community-dwelling older people: systematic literature reviewPublication . Sousa, Luís Manuel Mota; Marques-Vieira, Cristina Maria Alves; Caldevilla, Maria Nilza Guimarães Nogueira de; Henriques, Cristina Maria Alves Dias; Severino, Sandy Silva Pedro; Caldeira, Sílvia Maria AlvesObjective: To identify the risk factors for falls of the community-dwelling elderly in order to update the Taxonomy II of NANDA International. Method: A systematic literature review based on research using the following platforms: EBSCOHost®, CINAHL and MEDLINE, from December 2010 to December 2014. The descriptors used were (Fall* OR Accidental Fall) AND (Community Dwelling OR Community Health Services OR Primary health care) AND (Risk OR Risk Assessment OR Fall Risk Factors) AND (Fall* OR Accidental Fall) AND (Community Dwelling OR older) AND Nurs* AND Fall Risk Factors. Results: The sample comprised 62 studies and 50 risk factors have been identified. Of these risk factors, only 38 are already listed in the classification. Conclusions: Two new categories of risk factors are proposed: psychological and socio-economical. New fall risk factors for the community-dwelling elderly have been identified, which can contribute to the updating of this nursing diagnosis of the Taxonomy II of NANDA International.