VALIDATION THE NURSING DIAGNOSIS
INEFFECTIVE BREATHING ON THE INTENSIVE CARE UNIT
FOR ADULT PATIENTS
Soňa Bocková, Jana Marečková
Faculty of Health Sciences, Palacký University Olomouc, CZECH REPUBLIC
Nursing & Emergency Medicine, December 02-04 2013 Las Vegas, USA
PURPOSE
Main objective:
Implement the content validation of the individual diagnostic elements
(defining characteristics and related factors) of diagnosis Ineffective breathing - 00032 using Fehring model - Diagnostic Content Validity Model - DCV (1986).
Sub-objectives:
1. Selection of experts for validation of Ineffective breathing - 00032. 2. Preparation of protocols for data collection.
3. Perform content validation of diagnostic components of nursing diagnosis.
4. Finding out if there is a statistical relationship between a defining characteristics. 5. Finding out if there is a statistical relatioship between a related factors.
Research question
“
What diagnostic elements of diagnosis Ineffective breathing – 00032
will
be i
dentified
as
the main
diagnostic features,
what will be labeled as
minor
diagnostic elements
SAMPLE
• 52 ICU experts (nurses selected according to criteria)
• 100 % female
• median age 34.5 years (mean 33.5 years), min. 23 years, max. 47 years
• the median length of experience 6.0 years (mean 8.0 years)
• professional experience ranging 1-20 years: 1 year professional experience – 6
nurses, 5 years professional experience – 2 nurses, 10 years professional experience – 2 nurses, 20 years professional experience – 1 nurse
• 5 hospitals in the Czech Republic (Hospital Ostrava Fifejdy, Hospital Vitkovice,
CRITERIA FOR SELECTION OF EXPERTS
• specialisation in intensive or anesthesiology care
• clinical practice
• minimum 1 year of clinical practice
• thesis topic nursing diagnoses
• practical experiences with nursing diagnoses
• article with research results on the topic nursing diagnosis
(YES – 1 point, NO – 0 point)
METHODS
• criteria for the selection of experts according Fehring, modified by Zeleníková and Žiaková (2008, pp. 75–82), were listed earlier
• validation by experts according to Fehring model – DCV – Diagnostic Content Validity (1987, p. 3)
First were presented two protocols to experts for data collection: a) mapping criteria for the selection of experts according Fehring
b) protocol containing 16 defining characteristics and 16 related factors Ineffective breathing - 00032 (Herdman et al., 2012, s. 233) and two defining characteristics and two related factors suggested researchers for the project according to Fehring (1987, p. 2)
METHODS
Second experts carried out to assess the representativeness of each dignostic elements on their experiences using Likert scale from 1 to 5, where the value of five represented the highest degree of representativeness.
METHODS
• Following the methodology of Fehring model were the values obtained from 52 experts awarded scales ranging from 0 to 1.00. For grade of Likert scale:
1 - weight 0 2 - weight 0.25 3 - weight 0.50 4 - weight 0.75 5 - weight 1.00.
METHODS
By calculating the average of the sum of the weights of each validated diagnostic element was determine its weighted score significance.
• Spearman correlation coefficient, at 0.05 level of statistical significance
• selected defining characteristics and related fcators were compares
RESULTS OF VALIDITY
a) validity of DEFINING CHARACTERISTICS:
- as a major DCH Ineffective breathing - 00032 was evaluated one - dyspnea (weighted score of 0.84)
- 13 had already been identified as an minor - 4 have already been identified as insignificant
b) validity of RELATED FACTORS: - no RF was identified as major
- 14 RF evaluated into the category minor - 4 were identified as insignificant
MINOR AND INSIGNIFICANT DEFINING
CHARACTERISTICS
MINOR
(0,74) – Use of accessory muscles to breathe (0,73) – Orthopnea, Tachypnea
(0,70) – Assumption of three-point position (0,68) – Bradypnea
(0,62) – Alterations in depth of breathing (0,62) – Prolonged expiration phase
(0,59) – Decreased minute ventilation (0,57) – Decreased inspiratory pressure (0,56) – Decreased expiratory pressure
(0,55) – Decreased vital capacity, Prolonged expiration phase
(0,52) – Altered chest excursion
INSIGNIFICANT
(0,32) – Pursed-lip breathng
(0,40) – Balanced expiratory pressure, Increased anterior-posterior diameter
MINOR AND INSIGNIFICANT RELATED FACTORS
MINOR (0,78) – Hyperventilation
(0,71) – Hypoventilation syndrome, Pain (0,70) – Anxiety
(0,63) – Spinal cord injury
(0,60) – Musculoskeletal impairmant
(0,58) – Neurological immaturity, Respiratory muscle fatigue
(0,57) – Obesity
(0,56) – Body position, Fear
(0,55) – Fatigue, Neuromuscular dysfunction (0,52) – Chest wall deformity
INSIGNIFICANT
(0,49) – Perception impairment, Cognitive impairment
(0,48) – Helplessness (0,35) – Bony deformity
RESULTS OF SPEARMAN´S CORRELATION
• a strong positive correlation found between DCH „decreased expiration pressure" and „decreased inspiration pressure" (r = 0.831)
• a strong positive correlation between RF "musculoskeletal impairment"
and"neuromuscular dysfunction" (r = 0.710) and between "neurological immaturity" and " neuromuscular dysfunction "(r = 0.732)
REFERENCES
1. FEHRING, J. R. 1987. Methods to validate nursing diagnoses. Nursing Faculty Research and Publications [online]. 1987, p. 1–9. [cit. 2010-04-08]. Dostupný z www:
http://epublications.marquette.edu/cgi/viewcontent.cgi?article=1058&context=nursing_fac.
2. HERDMAN, T. H., et al. Nursing Diagnoses Definitions and Classification 2009-2011. 1st edition. United Kingdom: Willey-Blackwell, 2012. 512 p. ISBN 9780470654828.
3. MAZALOVÁ, L. MAREČKOVÁ, J. Typy validity ve výzkumu komponent NANDA International. Profese online. 2012, p. 11-15. ISSN 1803-4330.
3. ZELENÍKOVÁ, R. ŽIAKOVÁ, K. Expert v procese validizácie ošetrovateľských diagnóz. In BUŽGOVÁ, R., SIKOROVÁ, L. Ošetřovatelská diagnostika a praxe založená na důkazech II. Ostrava: Repronis, 2008. p. 75-82. ISBN 978-80-7368-499-0.
