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Abstract(s)
Introdução: 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
Introduction Nursing diagnoses represent a clinical judgement about human responses to life and health processes, incorporated in domains of nursing knowledge and competencies. Defining diagnoses of spiritual nature is made difficult by the subjectivity and complexity of the concept of spirituality, even though patients have spiritual needs. The nursing diagnosis of spiritual distress is included in NANDA-I since 1978 and has been subject of validation studies with meagre clinical validation to achieve improvement of its low level of evidence. Objectives: To perform the content validation and clinical validation of the NANDA-I nursing diagnosis of Spiritual Distress; to identify the prevalence of this diagnosis in the sample of cancer patients under chemotherapy; to find out the sensitivity, specificity and predictive value of the defining characteristics of the diagnosis. Methodology: The validation is based on the models of Richard Fehring. It was performed between February 2011 and April 2012 in three distinct phases. The first phase consisted of an integrative literature review of the concept and clinical indicators of spiritual distress. During the second phase the content validation with Portuguese expert nurses was carried out and it occurred simultaneously with the third phase of clinical validation through the interview of cancer patients under chemotherapy. The patients were interviewed to fill in a form that included the defining characteristics and the three criteria to identify the diagnosis: the patient’s opinion, the diagnosis by the researcher and a questionnaire of spiritual well-being. Results: From the integrative literature review a sample of 37 articles was identified from which 10 were validation studies, and among these one reported a clinical validation. A total of 35 clinical indicators of spiritual distress were identified. A semantic comparison between the results obtained and NANDA-I was performed by spirituality researchers, resulting in 40 indicators for validation. A suggestion for a new definition of the diagnosis resulted from this revision. During the content validation phase a sample of 42 experts was obtained from these 41 agreed with the suggestion for the new definition of the diagnosis. Additionally to the class 3 of domain 10, the experts suggested other classification for the diagnosis. The totality of characteristics was validated: 18 major characteristics and 22 minor characteristics. On the third phase a sample of 170 patients was obtained. The representative patient was a female, catholic, with 56.2 years of age, diagnosed for 24 months and under treatment for 15 months. The prevalence of spiritual distress was 40.8%. The 16 defining characteristics were validated. The 12 major characteristics of this study obtained considerable values of sensitivity and predictive value for the diagnosis, it being the case that 7 of this characteristics are not included in NANDA-I because they emerged from phase 1 of the study. The highest sensitivity value was from the defining characteristic expresses suffering and the highest specificity value was from the defining characteristic lack of meaning in life. Conclusions: The NANDA-I spiritual distress diagnosis needs a review of its classification regarding domain, definition and defining characteristics. The prevalence of the diagnosis confirms nurses will find patients with spiritual distress and need to gain competences for adequate interventions. Clinical validation in other contexts is paramount to add more evidence to the one gathered with this study and it has proven itself a method that will allow the understanding of the defining characteristics and the diagnosis with enhanced precision. More validation studies will contribute to the development of taxonomy and clinical practice, considering they will offer nurses information to define diagnoses in a process of care that is intended to be effective and efficient.
Introduction Nursing diagnoses represent a clinical judgement about human responses to life and health processes, incorporated in domains of nursing knowledge and competencies. Defining diagnoses of spiritual nature is made difficult by the subjectivity and complexity of the concept of spirituality, even though patients have spiritual needs. The nursing diagnosis of spiritual distress is included in NANDA-I since 1978 and has been subject of validation studies with meagre clinical validation to achieve improvement of its low level of evidence. Objectives: To perform the content validation and clinical validation of the NANDA-I nursing diagnosis of Spiritual Distress; to identify the prevalence of this diagnosis in the sample of cancer patients under chemotherapy; to find out the sensitivity, specificity and predictive value of the defining characteristics of the diagnosis. Methodology: The validation is based on the models of Richard Fehring. It was performed between February 2011 and April 2012 in three distinct phases. The first phase consisted of an integrative literature review of the concept and clinical indicators of spiritual distress. During the second phase the content validation with Portuguese expert nurses was carried out and it occurred simultaneously with the third phase of clinical validation through the interview of cancer patients under chemotherapy. The patients were interviewed to fill in a form that included the defining characteristics and the three criteria to identify the diagnosis: the patient’s opinion, the diagnosis by the researcher and a questionnaire of spiritual well-being. Results: From the integrative literature review a sample of 37 articles was identified from which 10 were validation studies, and among these one reported a clinical validation. A total of 35 clinical indicators of spiritual distress were identified. A semantic comparison between the results obtained and NANDA-I was performed by spirituality researchers, resulting in 40 indicators for validation. A suggestion for a new definition of the diagnosis resulted from this revision. During the content validation phase a sample of 42 experts was obtained from these 41 agreed with the suggestion for the new definition of the diagnosis. Additionally to the class 3 of domain 10, the experts suggested other classification for the diagnosis. The totality of characteristics was validated: 18 major characteristics and 22 minor characteristics. On the third phase a sample of 170 patients was obtained. The representative patient was a female, catholic, with 56.2 years of age, diagnosed for 24 months and under treatment for 15 months. The prevalence of spiritual distress was 40.8%. The 16 defining characteristics were validated. The 12 major characteristics of this study obtained considerable values of sensitivity and predictive value for the diagnosis, it being the case that 7 of this characteristics are not included in NANDA-I because they emerged from phase 1 of the study. The highest sensitivity value was from the defining characteristic expresses suffering and the highest specificity value was from the defining characteristic lack of meaning in life. Conclusions: The NANDA-I spiritual distress diagnosis needs a review of its classification regarding domain, definition and defining characteristics. The prevalence of the diagnosis confirms nurses will find patients with spiritual distress and need to gain competences for adequate interventions. Clinical validation in other contexts is paramount to add more evidence to the one gathered with this study and it has proven itself a method that will allow the understanding of the defining characteristics and the diagnosis with enhanced precision. More validation studies will contribute to the development of taxonomy and clinical practice, considering they will offer nurses information to define diagnoses in a process of care that is intended to be effective and efficient.
Description
Keywords
Enfermagem Diagnóstico de enfermagem Espiritualidade Estudos de validação Nursing Nursing diagnosis Spirituality Validation studies