Fatigue in patients with heart failure: A study of diagnostic accuracy fatigue in patients with heart failure.

PURPOSE: To analyze the accuracy of defining characteristics of the NANDA International nursing diagnosis, fatigue (00093), in patients with heart failure. METHODS: A cross-sectional study on the diagnostic accuracy of the defining characteristics of the nursing diagnosis. The sample consisted of 96 patients with heart failure in treatment in a public hospital. The latent class analysis method was used to test the accuracy measurements and estimate the prevalence of the diagnosis. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte. RESULTS: The prevalence of the fatigue nursing diagnosis was 42.54%. Increased physical symptoms (0.9988) and tiredness (0.9988) were the sensitive defining characteristics. Disinterested in surroundings (0.9999) was the specific defining characteristics. CONCLUSIONS: A set of three defining characteristics of the nursing diagnosis of fatigue was accurate in patients with heart failure. Thus, this set can be used by nurses to confirm nursing diagnosis fatigue in patients with heart failure. IMPLICATIONS FOR NURSING PRACTICE: This research contributes by providing accurate defining characteristics of fatigue in patients with heart failure. Thus, nurses should recognize the nursing diagnosis of fatigue in patients with heart failure through accurate defining characteristics and propose rapid and effective nursing interventions that have positive health results.

Predictors of pressure ulcer risk in adult intensive care patients: A retrospective case-control study.

OBJECTIVES: To evaluate the predictive power of risk factors for pressure ulcers in adult intensive care patients. METHOD: A retrospective case-control study was performed utilising a heterogeneous sample group allocated into a case group with pressure ulcers (n=90) and a control group without pressure ulcers (n=90). The analysis explored the predictive power of risk factors for pressure ulcers using a hierarchical logistic regression model. RESULTS: The risk factors that predicted pressure ulcers were friction (OR=5.97), previous history of pressure ulcers (OR=5.43), prolonged intensive care unit stay (OR=3.92), dehydration (OR=3.18), elevated skin temperature by 1-2°C (OR=3.12) and treatment of other comorbidities (OR=2.79). CONCLUSION: Adult intensive care patients have an increased risk of developing a pressure ulcer. These risk factors are regarded as strong predictors for pressure ulceration. This study advances nursing knowledge in that it investigates additional risk factors for the development of pressure ulcers and it identifies a set of factors that best predict their occurrence, which may contribute to the nurses' diagnostic reasoning in the intensive care unit.

Clinical validation of the nursing diagnosis of ineffective protection in haemodialysis patients.

AIMS AND OBJECTIVES: To evaluate the clinical validity of indicators of the nursing diagnosis of "ineffective protection" in haemodialysis patients. BACKGROUND: Haemodialysis patients have reduced protection. Studies on the nursing diagnosis of "ineffective protection" are scarce in the literature. The use of indicators to diagnose "ineffective protection" could improve the care of haemodialysis patients. The clinical usefulness of the indicators requires clinical validation. DESIGN: This was a diagnostic accuracy study. METHOD: This study assessed a sample of 200 patients undergoing haemodialysis in a reference clinic for nephrology during the first half of 2015. Operational definitions were created for each clinical indicator based on concept analysis and content validation by experts for these indicators. Diagnostic accuracy measurement was performed with latent class analysis with randomised effects. RESULTS: The clinical indicator of "fatigue" had high sensitivity (p = .999) and specificity (p = 1.000) for the identification of "ineffective protection." Additionally, "maladaptive response to stress" (p = .711) and "coagulation change" (p = .653) were sensitive indicators. The main indicators that showed high specificity were "fever" (p = .987), "increased number of hospitalisations" (p = .911), "weakness" (p = .937), "infected vascular access" (p = .962) and "vascular access dysfunction" (p = .722). CONCLUSION: A set of nine clinical indicators of "ineffective protection" were accurate and statistically significant for haemodialysis patients. Three clinical indicators showed sensitivity, and six indicators showed specificity. RELEVANCE TO CLINICAL PRACTICE: Accurate measures for nursing diagnoses can help nurses confirm or rule out the probability of the occurrence of "ineffective protection" in patients undergoing haemodialysis.

Pressure Ulcer Risk Evaluation in Critical Patients: Clinical and Social Characteristics.

BACKGROUND: Pressure ulcers increase hospital stays and treatment costs due to their complications. Therefore, recognizing factors that contribute to pressure ulcer risk are important to patient safety. OBJECTIVE: To evaluate the association between the scores of the Waterlow, Braden, and Norton scales and clinical and social characteristics in critically ill patients. METHOD: A cross-sectional study of 78 patients in an adult intensive care unit of a university hospital in Northeastern Brazil was conducted from July to December 2015. Data included social and clinical information and the risk factors of the Braden, Norton and Waterlow scales. Data were analysed by the descriptive and inferential statistics. RESULTS: Most of the participants were female, adults and elderly people with brown skin colour, low education levels and insufficient income. Most of them showed a high risk for developing pressure ulcers using the three evaluated scales. Age, smoking status, diabetes and hypertension were associated with scores on the Waterlow, Braden and Norton scales. CONCLUSION: Age, use of the tobacco, diabetes and hypertension were associated with the risk of pressure ulcers in ICU patients.