International Journal of Nursing Knowledge最新文献

Purpose: To determine the accuracy of nursing diagnoses at hospital admission and discharge for patients with heart failure (HF).

Methods: This comparative study examined the documentation in 155 medical records of patients with an admitting diagnosis of HF during August 2018 and July 2019. An audit tool was used to record the diagnoses made by nurses during routine care at the time of admission and discharge. Two researchers (L.S. and A.C.) examined the records and evaluated the documented nursing diagnoses using the Nursing Diagnosis Accuracy Scale version 2. Kappa was used for agreement between them. Patient social and clinical characteristics were described using percentages, absolute frequencies, means, and standard deviations.

Findings: A total of 18 unique nursing diagnoses were identified across the 155 patients. Among the 754 nursing diagnoses recorded, 85% of those identified at admission (n = 644) were deemed highly accurate. At discharge, of the 527 diagnoses recorded, 66% (n = 349) were rated as highly accurate. Excess fluid volume was the most common diagnosis (85% at admission, 49% at discharge). Three risk diagnoses were frequent at both points: risk for infection, risk for falls, and risk for decreased cardiac output. Agreement between evaluators ranged from Κ = 0.234 to 1.00.

Conclusions: Greater agreement in nursing diagnoses at discharge likely reflects ongoing patient monitoring. Persistent diagnoses at discharge highlight the need for continued nursing care post-discharge.

Implications for nursing practice: This study encourages nurses to improve clinical evaluation for HF patients from admission to discharge. As key clinical indicators are identified, nurses can improve the accuracy of their diagnoses and plan more effective interventions to achieve positive health outcomes and reduce unnecessary hospitalization.

Objective: The objective of study was to present evidence of the content validity of conceptual and operational definitions of the "Blood Transfusion Reaction (code 0700)" nursing outcome from the Nursing Outcomes Classification (NOC).

Method: A methodological study was implemented in four phases. The first phase consisted of a narrative literature review in which the main indicators related to blood transfusion were identified: 25 new indicators that were not present in NOC, in addition to 14 existing indicators, for a total of 39 to be studied. In the second phase, conceptual and operational definitions, and magnitude of NOC indicators were developed. The third phase consisted of analysis of evidence of content validity of conceptual and operational definitions of indicators, through assessment by experts. In the fourth phase, a pilot test was applied to 40 electronic medical records of patients who received blood components and presented with a transfusion reaction.

Results: A total of 27 articles were analyzed and served as support to develop conceptual and operational definitions, and magnitude of indicators, considered for the outcome under study. It was assessed by a group of 10 experts, requiring three rounds to reach the established critical content validity ratio in which four of these indicators were excluded, leaving 35 indicators in the final version. A pilot test on 40 records revealed the presence of 13 indicators, of which six were present in the classification.

Conclusion: The conceptual and operational definitions and magnitude developed for the "Blood Transfusion Reaction (code 0700)" nursing outcome demonstrated adequate evidence of content validity in the 21 indicators found in the literature, along with 14 indicators already present in NOC, and 13 of these indicators were present in patients receiving blood components who presented a transfusion reaction.

Implications for practice: Nurses can use this nursing outcome as a clinical assessment tool for monitoring blood transfusion recipients' clinical signs.

Objective: To evaluate the accuracy of the defining characteristics of the nursing diagnosis Impaired skin integrity (00046) in patients admitted to intensive care units (ICUs).

Methods: A cross-sectional diagnostic accuracy study was conducted with 105 adult patients admitted to an ICU. A latent class model with random effects was used to test the sensitivity and specificity of the defining characteristics investigated. The diagnosis Impaired skin integrity (00046) was the dependent variable, whereas sociodemographic and clinical data were the independent variables.

Results: Impaired skin integrity was present in 3.75% of the sample. The defining characteristic with the best accuracy for the diagnosis was dry skin, with high sensitivity (0.9994) and specificity (0.9106). Other characteristics stood out in terms of sensitivity measures: altered skin color (0.9994) and foreign matter piercing skin (0.9994). In terms of specificity, the following stood out: desquamation (1.000), localized area hot to touch (0.9901), pruritus (0.9897), bleeding (0.9802), and hematoma (0.9208).

Conclusion: The defining characteristics that helped infer the diagnosis Impaired skin integrity (00046) with greater certainty were dry skin, altered skin color, foreign matter piercing skin, desquamation, localized area hot to touch, pruritus, bleeding, and hematoma.

Implications for nursing practice: Identifying defining characteristics with high diagnostic accuracy for Impaired skin integrity (00046) enables nurses to expand their clinical perspective on this dysfunction, which can affect the skin of critically ill patients, and to develop individualized care plans.

Objective: To clinically validate the nursing diagnosis (ND) inadequate social support network in breastfeeding mothers.

Method: This cross-sectional quantitative study employed clinical indicator accuracy analysis and hierarchical modeling for the etiological factors of the ND inadequate social support network. The study included 285 breastfeeding mothers registered in primary healthcare units.

Results: The most prevalent clinical indicators within the sample were deficit in instrumental support from health services, imposition of appropriate behaviors, weak social bonds, and negative social interactions. The most frequent etiological factors were deficit in strong bonds, fragility of institutional network organization, unwillingness to provide support, refusal to provide support, and deficit in healthcare professionals.

Conclusion: The ND inadequate social support network was clinically validated within the population of breastfeeding mothers, resulting in six clinical indicators with high sensitivity and specificity for identifying the diagnosis. Additionally, the statistical analysis of the etiological factors identified seven antecedents to the emergence of the diagnosis.

Implications for nursing practice: Based on these findings, nurses can better assist breastfeeding mothers with the aim of preventing an inadequate social support network. By identifying this phenomenon, it becomes possible to plan care and implement nursing interventions to address this issue effectively.

Purpose: To quantitatively pool the overall prevalence of self-neglect in older adults and provide evidence-based information for healthcare professionals to develop preventive measures.

Methods: Systematically and thoroughly searched ten databases from inception to September 1, 2024 and we pooled the prevalence of self-neglect in older adults using a random-effects model based on the Stata 15.0 software.

Results: In our meta-analysis, 21 studies were included, and the estimated prevalence rate of self-neglect among older adults was 27% (95% CI: 23%-30%). We found that the incidence of self-neglect was higher in males, aged 80 years, developing countries, hospitals, and using the Elder Self-Neglect Questionnaire assessment tool.

Conclusion: Self-neglect is a common and underestimated phenomenon in older adults, and the prevalence rate of self-neglect is high. Several epidemiological characteristics such as gender, age, countries, settings, and definition criteria were associated with its prevalence. It deserves early screening and targeted intervention by using a globally accepted definition of self-neglect to prevent older adults from self-neglect.

Implications for nursing practice: Our study can provide clinical evidence for nursing staff and healthcare professionals to identify high-risk groups of self-neglect in older adults.

Purpose: This purpose of this article was to use the method of conceptual history to analyze the evolution of the concept of "validity" in nursing diagnoses and to identify key transformations, theoretical influences, and implications for contemporary clinical judgment and decision-making.

Methods: Five stages derivate from the approach proposed by Reinhart Koselleck, including: identify the concept and its relevance, historical contextualization, contextual use, semantic changes over time, and synthesis and interpretation.

Findings: The concept of "validity" in nursing diagnoses is essential for accurate diagnostics, interdisciplinary communication, and evidence-based decision-making, though its interpretation varies due to differing philosophical perspectives and methodological challenges. Historically, "validity" in nursing evolved from empirical methods to theory-driven approaches incorporating psychometric and clinical frameworks. Validation processes have adapted, integrating scientific rigor, ethical considerations, and practical utility, while also reflecting societal, technological, and cultural shifts. Today, the focus is on balancing methodological diversity and evidence-based practice, with a need for continuous quality improvement, interdisciplinary collaboration, cultural sensitivity, and patient involvement.

Conclusions: The concept of "validity" in nursing diagnoses has evolved from early empirical methods to its current focus on evidence-based practices, interdisciplinary integration, and cultural sensitivity, emphasizing the need for accurate, technologically informed diagnostics to enhance patient care and guide clinical decision-making.

Implications for nursing practice: Nursing must integrate diverse perspectives, cultural sensitivity, and technology into its diagnoses, and professionals should be trained in both scientific and ethical aspects to improve patient outcomes.

Purpose: This study aimed to establish the content validity of the proposed nursing diagnosis (ND) "Adult Disuse Syndrome" and all its components.

Method: This is an exploratory descriptive study of diagnostic content validation under Fehring's proposal. Forty three expert nurses with clinical, teaching, and research experience analyzed the components of the diagnosis. The representativeness and relevance of the components of the diagnosis under study were evaluated through a Likert-type questionnaire. Data distribution analysis was carried out, and the components were validated if their content validity index (CVI) was over 0.80. The overall CVI was obtained for the clinical indicators.

Findings: A total of 12 defining characteristics (DCs) were validated, 3 etiological factors were highly related, 6 risk populations were confirmed, and 11 conditions were considered associated. Most validated DCs refer to the physical dimension, but those focusing on the psychological and social dimensions were also validated. The etiological factors were related to the effects of immobility. The risk populations were validated in different contexts or situations, and associated conditions were mainly oriented toward chronic conditions.

Conclusions: This study validated the content of the elements of the proposed ND "Adult Disuse Syndrome." These were considered relevant and appropriate by both academic and clinical experts.

Implications for nursing practice: The content validation by experts of the components of the ND "Adult Disuse Syndrome" provides nurses with a tool for the identification of the phenomenon that exceeds the risk and occurs frequently in patients exposed to the effects of immobility. At the same time, it will guide the results pursued in the care plan and the application of the respective nursing and interdisciplinary interventions that favor the reduction of the complications derived from disuse.

Purpose: To develop an intervention enhancing hospitalized older adults' nutrition.

Methods: For the first time, a mixed-methods design with data triangulation was applied according to the six-step model of Corry et al. to elaborate on a complex nursing intervention in the form of a logic model. Patients who were aged ≥80 years and hospitalized for at least 5 days were included. Sample size for quantitative practice analysis was 135 older adults, whereas 22 older inpatients participated in interviews and observations for needs analysis and generated data for key principles.

Findings: The intervention "Eat Enough" encompasses nursing team culture and comprises six actionable targets to deliver needs-based support and reach required protein and energy intake for hospitalized older adults by sensitizing nurses and the interprofessional team. Facilitating nutritional intake would be supported by an advanced practice nurse who considers the medical and nursing care plan and therapy.

Conclusions: The intervention "Eat Enough" demonstrates that nurses play a key role in interprofessional teams to enhance older adults' nutrition in hospital. The pipeline model displays how the actionable targets can be achieved, and how awareness raising can influence the context-leading to raised calories and protein requirement coverages and shorter length of stay.

Implications for clinical practice: By identifying risk factors of malnutrition and strengthening nurses' responsibilities, the intervention "Eat Enough" could significantly enhance nutrition among hospitalized older adults. However, the logic model should be tested and implemented in future research.

Purpose: To analyze evidence of content validity of the nursing diagnosis (ND) Risk for Unstable Blood Pressure in incarcerated women.  METHOD: A methodological study assessing the content validity of an ND, was performed in Brazil, between June and September 2022, with 49 nurses as experts. The label, definition, and relevance of the 19 risk factors of the ND Risk for Unstable Blood Pressure were appraised. Based on the predictive diversity model, the content validity index (CVI) and respective 95% confidence intervals were calculated for each risk factor. A CVI ≥ 0.8 was considered adequate evidence of content validity.

Findings: The label and the definition of the diagnosis was reformulated. The relevance of 19 etiological factors showed a CVI ≥ 0.8. According to the recommendation of the panel of experts, one of the etiological factors was split in two and two label of etiological factors were changed.

Conclusions: A new label (Risk for Imbalanced Blood Pressure), new definition, and 20 etiological factors (11 risk factors, five associated conditions, and four at-risk populations) of the ND Risk for Unstable Blood Pressure in incarcerated women were considered valid.

Implications for nursing practice: NANDA-I accepted the proposal for this nursing diagnosis; hence this study contributed to updating the classification based on scientific evidence. This evidence will favor diagnostic reasoning and recognition of the diagnosis during clinical assessment, and support studies assessing the clinical validity of these elements in incarcerated women.

Purpose: To identify and synthesize evidence regarding the documented relationship between the standardized nursing terminologies and the unfinished nursing care phenomenon.

Data sources: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete databases were last consulted on November 27, 2023. The review included primary quantitative studies that reported an association between recognized standardized nursing terminologies and unfinished nursing care. Two researchers completedtitle and abstract and full-text screening.

Data synthesis: Our search identified 149 citations. A full-text review of one paper was undertaken. No studies met our inclusion criteria. We report an empty review.

Conclusions: Standardized nursing terminologies and Unfinished Care are two sides of the same coin: despite their potential commonalities, no studies have documented their potential links. Digital systems, such as electronic health records and decision support systems, could foster this linkage.

Implications for nursing practice: This review suggests that linking the conceptual frameworks can promote the diffusion of standardized nursing terminologies in clinical practice and increase accuracy in the measurement of Unfinished Care. This synergy could promote the contribution of nursing knowledge to patient care, nursing visibility, and be beneficial to clinical nurses, managers, and healthcare systems to international level.