Simultaneous concept analysis of nursing diagnoses related to respiratory function.

AIM: To perform a simultaneous concept analysis of the concepts associated to nursing diagnoses ineffective airway clearance, ineffective breathing pattern, and impaired gas exchange. BACKGROUND: Concepts about respiratory manifestations need to be well defined, especially in the current pandemic scenario. For that, the simultaneous concept analysis can help in the clarity and differentiation of similar concepts. METHODS: A concept analysis using the Walker and Avant approach and an integrative review. Data were collected by a group of nurses through a literature review. The group identified 10 articles that met the inclusion criteria and complemented the understanding of the concepts analysed through the sequential description of respiratory physiology in technical books. RESULTS: The final list included 28, 22, and 21 clinical indicators for ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance, respectively. The former, the final proposal incorporated 13 indicators that were pointed out by the group and 15 defining characteristics of NANDA-International. For Impaired gas exchange, the indicator "decreased oxygen saturation" was included; among the defining characteristics of NANDA-International, "abnormal arterial blood gases" was excluded, and "abnormal breathing pattern" was subdivided into "alterations in respiratory depth," "bradypnea," "tachypnea," and "change in respiratory rhythm." The latter, only the "wide-eyed" was removed from the final list of clinical indicators, which subsequently consisted of nine indicators suggested by the group and 12 defining characteristics. CONCLUSION: This concept analysis may aid in the process of differentiation for ineffective airway clearance, ineffective breathing pattern, and impaired gas exchange, and aid in safer diagnostic inference. This concept analysis can support the understanding of respiratory nursing diagnoses, helping nurses to identify and differentiate them more safely.

Unidimensional analysis of the nursing diagnoses of situational low self-esteem and chronic low self-esteem.

PURPOSE: To analyze the unidimensionality of the nursing diagnoses low situational self-esteem and low chronic self-esteem proposed by NANDA-I. DESING AND METHODS: Diagnostic accuracy study carried out with 180 patients with depressed mood in a psychiatric hospital in northeastern Brazil. FINDINGS: The analysis of the latent class considered the hypothesis of low self-esteem as a unique construct and included the indicators: Excessive seeking of reassurance, repeatedly unsuccessfulness in life events, rejection of positive feedback, insomnia, solitude, and nonassertive behavior. PRACTICE IMPLICATIONS: The recognition of low self-esteem as a unique diagnostic construct allows nurses to be more assertive in the provision of care.

Clinical validation of the nursing diagnosis of impaired memory in patients with a stroke.

AIM: To validate the clinical indicators for the nursing diagnosis of impaired memory among patients with a stroke. METHODS: A sample of 123 patients who had been admitted with a stroke was evaluated by using a questionnaire that was designed to identify the presence of the clinical indicators for the diagnosis of impaired memory, according to the NANDA International taxonomy. Measures of sensitivity and specificity were calculated for each clinical indicator by using random-effects latent class analysis. RESULTS: The clinical indicators that demonstrated high levels of diagnostic accuracy included the following: an inability to learn new skills and an inability to retain new skills. The inability to learn new skills and the inability to carry out previously learned skills were identified as the clinical indicators with high sensitivity and specificity in the latent class model with adjustment for age. The inability to retain new skills indicator showed better diagnostic accuracy in individuals with lower educational levels. CONCLUSION: The clinical indicators of the impaired memory diagnosis were observed frequently in patients with a stroke; in these patients, impaired memory was characterized by the inability to learn or retain new skills and was influenced by the age and educational level.

Clinical validation of the NANDA-I diagnosis of impaired memory in elderly patients.

PURPOSE: The aim of this study was to perform a clinical validation of the defining characteristics of impaired memory (IM) in elderly patients at a long-term care institution. METHODS: A sample of 123 elderly patients was evaluated with a questionnaire designed to identify IM according to the NANDA-I taxonomy. Accuracy measures were calculated for the total sample and for males and females separately. RESULTS: Sensitivity and specificity values indicated that: (1) inability to learn new skills is useful in screening IM, and (2) forgets to perform a behavior at a scheduled time, forgetfulness, inability to learn new information, inability to recall events, and inability to recall factual information are confirmatory indicators. CONCLUSION: Specific factors can affect the manifestation of IM by elderly patients. The results may be useful in improving diagnostic accuracy and efficiency of the IM nursing diagnosis.

The construction and evaluation of new educational software for nursing diagnoses: a randomized controlled trial.

BACKGROUND: Student nurses often have difficulties with diagnostic inferences. To achieve high accuracy nursing diagnoses, effective learning strategies are required. OBJECTIVE: To describe the construction and evaluation of new educational software called Wise Nurse, which was developed to increase the capacity of student nurses to identify nursing diagnoses (NDx) and to establish relationships between NDx, defining characteristics (DC), and related factors (RF). DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: Participants were 2nd to 4th year student nurses from an undergraduate program at a university in Brazil. Of the 47 recruited students, 37 completed the survey. METHODS: Students were randomly assigned to test the software (experimental group) and to solve printed clinical cases (comparison group). A pretest and post-test were applied before and after the experiment. Statistical analyses of the students' performance in the tests were conducted. The primary outcome was the students' progress in solving questions and clinical cases regarding NDx. The System Usability Scale was used to measure the software's ease of use. RESULTS: No significant difference was found between the experimental and comparison groups before and after the experiment. The average students' performance in identifying RF and NDx was higher than in identifying DC. The post-test score was higher than the pretest score in both groups (P=0.022). The usability score was good (average score 83.75, N=20). CONCLUSION: The use of Wise Nurse supported an improvement in student diagnostic reasoning equivalent to that of the traditional NDx training, but the software stands out as an innovative teaching tool.

Pentacam Scheimpflug evaluation of corneal volume after LASIK.

PURPOSE: To assess the change in corneal volume and laser ablation volume over time after LASIK using a rotating Scheimpflug camera. METHODS: Twenty-six patients (49 eyes) underwent LASIK. Pentacam Scheimpflug measurements were performed pre- and postoperatively at 1, 3, 7, 15, and 30 days. Central corneal thickness, total corneal volume (10-mm diameter), and partial corneal volumes (3, 5, and 7 mm) based on the apex of the cornea, were measured. Main outcome measures were differences between pre- and postoperative volume measurements of total and partial corneal regions, volume changes over time postoperatively, and comparison between laser ablation volume and corneal volume. RESULTS: A strong linear relationship was noted between spherical equivalent refraction and laser ablation volume (r = -0.931, P < .0001). Furthermore, 30 days after LASIK, a strong linear relationship was noted between planned thickness and achieved thickness (r = 0.9457, P < .001). Corneal volumes for 3-, 5-, and 7-mm diameter regions significantly decreased over time postoperatively (one-way analysis of variance, P < .05). CONCLUSIONS: Alterations in corneal volume correlated with laser ablation volume when the diameter of the region considered was 3, 5, or 7 mm from the corneal apex.