Excessive fluid volume risk middle-range theory

ABSTRACT Objective to construct a middle range theory for developing the excessive fluid volume risk diagnostic proposition in patients undergoing hemodialysis. Method this is a methodological study, developed for the theoretical-causal validity of a nursing diagnosis. The study was carried out in four stages: study selection, identification of the main concepts of the theory, pictogram construction and proposition elaboration. These steps were operationalized through an integrative literature review, with a sample of 82 articles selected from the Web of Science, PubMed, CINAHL, Scopus and Science Direct databases. Results the data extracted from the sample articles enabled identifying five essential terms to define excessive fluid volume risk. Furthermore, 31 etiological factors of excessive fluid volume risk were identified, in addition to a pictogram and 12 propositions. Conclusion and implications for practice the construction of a middle-range theory focused on excessive fluid volume risk in patients undergoing hemodialysis refines terminology and expands the understanding of nursing phenomena. Thus, the data from this research will provide clear and robust knowledge for the conduct of nurses’ actions in clinical practice.

Accuracy of the defining characteristics of the nursing diagnosis hypothermia in patients on hemodialysis

ABSTRACT Objective: to analyze the accuracy of the defining characteristics of hypothermia in patients on hemodialysis. Methods: a diagnostic accuracy study was assembled within a cross-sectional study with 124 patients from two dialysis centers. A latent class model was used for data analysis. Results: the nursing diagnosis hypothermia was present in 13 (10.48%) study participants. The most prevalent defining characteristics were hypoxia (100%), decrease in blood glucose level (83.1%), hypertension (65.3%), piloerection (45.2%), and skin cool to touch (41.1%). The defining characteristics acrocyanosis (99.96%) and cyanotic nail beds (99.98%) had a high sensitivity. Acrocyanosis (91.8%), skin cool to touch (64.8%), and peripheral vasoconstriction (91.8%) had high specificity. Conclusion: specific and sensitive indicators of hypothermia work as good clinical indicators for confirming this diagnosis in patients on hemodialysis. The study findings can assist nurses in their clinical reasoning for a correct inference of hypothermia.

Teoria de médio alcance do risco de volume de líquidos excessivo

RESUMO Objetivo construir uma teoria de médio alcance para o desenvolvimento da proposição diagnóstica risco de volume de líquidos excessivo em pacientes em hemodiálise. Método trata-se de um estudo metodológico, desenvolvido para a validade teórico-causal de um diagnóstico de enfermagem. O estudo foi realizado em quatro etapas: seleção dos estudos, identificação dos conceitos principais da teoria, construção do pictograma e elaboração das proposições. Essas etapas foram operacionalizadas por meio de uma revisão integrativa da literatura, com uma amostra de 82 artigos selecionados nas bases de dados Web of Science, PubMed, CINAHL, Scopus e Science Direct. Resultados os dados extraídos dos artigos da amostra possibilitaram a identificação de cinco termos essenciais para a definição do risco de volume de líquidos excessivo. Além disso, foram identificados 31 fatores etiológicos do risco de volume de líquidos excessivo, além de construídos um pictograma e 12 proposições. Conclusão e implicações para a prática a construção de uma teoria de médio alcance voltada para o risco de volume de líquidos excessivo em pacientes em hemodiálise refina as terminologias e amplia a compreensão dos fenômenos da enfermagem. Assim, os dados desta pesquisa fornecerão conhecimentos claros e robustos para a condução das ações do enfermeiro na prática clínica.

Knowledge, attitude and practice of people with HIV regarding a healthy lifestyle: clinical trial

ABSTRACT Objective: To evaluate the effectiveness of an educational booklet on the knowledge, attitude and practice of a healthy lifestyle in people with HIV. Methods: Randomized clinical trial with 75 intervention group patients using the booklet, and 75 control group patients undergoing usual service care. Data collection occurred in four moments, with a Survey pertaining Knowledge, Attitude and Practice. Nonparametric analysis of variance of repeated measures was used. Results: 70 participants in the intervention group and 74 in the control group completed the study. In terms of knowledge, there was no difference between groups, the booklet impact came late, increasing after reassessments. In attitudes, there was a difference between groups in the two- and four-month reassessments compared to the baseline. In practices, there was a difference in the intervention group compared to the control group at two, four, and six months compared to baseline. Conclusion: The booklet was effective in improving healthy lifestyle knowledge, attitudes, and practices in people with HIV.

Effect of educational intervention on clinical reasoning skills in nursing: A quasi-experimental study

This study evaluated the effect of an educational intervention based on virtual clinical simulation and problem-based learning using a mobile application in a clinical nursing education context as a tool to improve clinical reasoning skills of students on the second year of nursing graduation. A prospective quasi-experimental study was conducted in the year 2018, and assessments were performed before and after the educational intervention. A random convenience sample (n = 32) of nursing students in the second year of a public university in Brazil was divided equally into experimental and control groups. The experimental group underwent educational intervention about clinical reasoning skills and measured the quality of the Diagnostician Nurse software by LORI 2.0 instrument. The control group experienced the conventional class on clinical reasoning skills. Four clinical cases were used to assess reasoning skills before and after the educational intervention. The data were analyzed using descriptive and inferential statistics. The experimental group showed a statistically significant difference regarding the prioritization of nursing diagnoses (p = 0.014) and a higher final score. There was a statistically significant difference in performance between the pre- and post-test in the grades of the students who participated in the intervention (p = 0.003). The control group also showed statistical significance in the score attributed to the clinical reasoning process (p = 0.015). In addition, the Diagnostician Nurse software had excellent usability and quality evaluations (SUS 87.81 and LORI 4.66, respectively). It is concluded that educational intervention based on virtual clinical simulation and learning problems using the Diagnostician Nurse software is effective as a tool to improve clinical reasoning skills and can support early detection of patients. The educational intervention developed was of high quality and attractive and improved students' motivation for the teaching-learning process.

Mortality, survival and prognostic factors of people with AIDS in intensive care unit

OBJECTIVE

To analyze mortality, survival and prognostic factors of patients with AIDS in Intensive Care Unit (ICU).

METHOD

Retrospective cohort study with a sample of 202 patients with AIDS in ICU, whose sociodemographic, epidemiological, and clinical characteristics were obtained from medical records and assessed.

RESULTS

Patients were mostly male (73.8%) and drug users (59.4%), with no regular health follow-up (61.4%) and no adherence to antiretrovirals (40.6%), presenting low CD4+ T lymphocyte count (94.0%) and high viral load (44.6%). The main causes of hospitalization were sepsis and respiratory and renal insufficiency. The mean duration of hospitalization was 11.9 days (p = 0.0001), with a 41.6% survival; 58.5% died in the ICU. Sepsis upon admission (p < 0.001), pressure injury (p = 0.038), sexual exposure (p = 0.002), high viral load (p = 0.00001) and prolonged hospitalization (p < 0.001) increased the risk of death.

CONCLUSION

Most patients had no regular health follow-up, were drug users and presented low CD4+ T lymphocyte count and high viral load. The high mortality indicated that antiretroviral adherence is essential to reduce viral resistance, opportunistic diseases, and mortality.

Impact of the Peace Agreement on the social determinants of health in Colombia

OBJECTIVES

to analyze the impact of the Colombian Peace Agreement on the structural social determinants of health.

METHODS

a descriptive, ecological study, based on documentary data from 2008 to 2018. The records of victims, epidemiological indicators, and structural social determinants of health in Colombia were analyzed.

RESULTS

there was a correlation between the period in which the Peace Agreement process was developed and the indicators of structural determinants in health with p<0.05. With the Poisson regression analysis, the favorable correlations between the peace process and the determinants were confirmed, besides allowing the understanding of the changes in these indicators before the Peace Agreement.

CONCLUSIONS

the implementation of the peace process has a positive impact on structural social determinants of health, which is observed by the beginning of the decrease of economic, educational, health, and social inequalities and inequities, a fact that offers the possibility of living in peace.

Clinical indicators and aetiological factors of sedentary lifestyle in patients with arterial hypertension

AIMS

The aim of this study is to verify the clinical validity of clinical indicators and aetiological factors of sedentary lifestyle in individuals with arterial hypertension.

BACKGROUND

Diagnostic validation is performed to expand nursing taxonomies and to revise or confirm the described concepts. New elements listed in the literature and those identified by the NANDA International definition for sedentary lifestyle need to be evaluated.

DESIGN

This is a cross-sectional and diagnostic validation study. The STROBE guidelines were used in this study.

METHODS

Two hundred and fifty subjects aged over 18 years were evaluated. The diagnostic status of the participants was obtained by latent class analysis. Logistic regression was used to identify aetiological factors with the manifestation of sedentary lifestyle, considering a significance level of 5%.

RESULTS

A total of 57.8% of the study participants met the diagnostic criteria for sedentary lifestyle. The clinical indicators with high sensitivity were as follows: "Average daily physical activity is less than recommended for gender and age"; "Does not perform physical activity during leisure time"; "Preference for activity low in physical activity" and "Overweight." The significantly related factors associated with the diagnosis of sedentary lifestyle were as follows: "Insufficient knowledge on physical activity," "Lack of time," "Negative self-perception of health," "Lack of security," "Lack of appropriate place," "Lack of motivation," "Activity intolerance," "Lack of sports ability," "Having a partner," "Using public transportation," "Perception of physical disability," "Pain," "Having a job/studying," "Laziness," "Impaired mobility," "Living in an urban area," "Education in a public institution," "Female gender," "Lack of confidence to practice physical exercise," "Education level," "Age" and "Lack of social support for the practice of physical exercise."

CONCLUSION

Four out of eight clinical indicators had a good adjustment by the latent class analysis. Of the 27 aetiological factors, 22 were significantly associated with sedentary lifestyle.

RELEVANCE TO PRACTICE

The correct identification of sedentary lifestyle and its elements supports care planning, especially for health promotion and disease prevention.

Content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects

OBJECTIVE

To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects.

METHOD

Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05.

RESULTS

The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy.

CONCLUSION

The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.

Content validation of the nursing diagnosis Risk for disturbed maternal-fetal dyad

OBJECTIVE

To validate the content of the diagnosis Risk for disturbed maternal-fetal dyad in high-risk pregnant women.

METHOD

Nursing diagnosis content analysis study in which 48 nurses evaluated agreement regarding title, definition, class, and domain of the studied nursing diagnosis, as well as the relevance of its antecedents. The items were considered relevant when the Confidence Interval of the Content Validity Index was 0.8 or higher. When lower, the item was modified or excluded according to the experts' suggestions.

RESULTS

Out of 21 antecedents, 14 were considered relevant. The labels of five elements considered irrelevant were changed, and one item was excluded. The experts did not choose the title and definition proposed by NANDA-I, preferring instead the ones suggested in this study. The experts agreed with the class and domain proposed by the taxonomy.

CONCLUSION

Ten risk factors, four populations at risk, and six associated conditions for this nursing diagnosis were maintained; these may provide a basis for nursing practice. The phase of clinical validation is suggested to be conducted to corroborate this study's results.

Nursing diagnosis "Terminality Syndrome": a content analysis

OBJECTIVES

to validate the nursing diagnosis "Terminality Syndrome" with experts.

METHODS

a quantitative research of content validation type based on collective wisdom approach. An online semi-structured questionnaire was used as an instrument for data collection, and Content Validity Index and Wilcoxon test were used for comparing possible differences.

RESULTS

the questionnaire was answered by 89 professionals after judges' assessment in relation to the structural components of the diagnosis proposed. The mean Content Validity Index of items was above that recommended, except for title, which was ≥ 0.8. The suggestions were reviewed and accepted, being forwarded for a new analysis, reaching 83.7% of agreement among participants.

CONCLUSIONS

the diagnosis' content proved to be valid by judges. With that, it is expected to contribute with a useful nursing diagnosis for nursing practice documentation in palliative care.

Content analysis of clinical indicators for Impaired gas exchange

OBJECTIVE

To analyze the relevance of clinical indicators and the clarity and precision of conceptual and operational definitions of the diagnosis Impaired gas exchange.

METHODS

Content analysis, by 39 nurse judges, divided into the phases of conceptual definition of the phenomenon of interest, construction of the structure of the phenomenon of interest and analysis of the judges on the built structure.

RESULTS

From the 22 indicators, 21 were considered relevant Impaired gas exchange. The indicators that obtained absolute relevance were Cyanosis, Hypercapnia, Hypoxemia and Tachycardia. The indicator Headache upon waking did not show any statistically significant relevance for the diagnosis. All conceptual and operational definitions were clear and precise.

CONCLUSION

The indicators listed for Impaired gas exchange were relevant to the phenomenon, except Headache upon waking because it does not correspond to a safe manifestation to identify the diagnosis, according to the analysis of the judges. Each conceptual and operational definition was adequate for its indicator.

Middle-Range Theory for the Nursing Diagnosis of Low Self-Efficacy in Health

OBJECTIVES

theoretical validation of the concept of low self-efficacy in health as a nursing diagnosis construct.

METHODS

construction of a middle-range theory for validating diagnoses, comprised of five stages: definition of the approach for building the theory; definition of the main concepts; creation of a pictorial diagram; formulation of proposals; establishment of causal relationships and evidence for clinical practice. The main concepts were identified through a literature review and the studies were taken from the LILACS, SCOPUS, CINAHL and PubMed/MEDLINE databases. The final sample was comprised of 92 articles.

RESULTS

eighteen etiological factors and 16 clinical indicators were identified; characterized as antecedents and manifestations for inferring a diagnosis of low self-efficacy in health.

CONCLUSIONS

the related concepts of the new nursing diagnosis of low self-efficacy in health, to be applied in clinical nursing practice, were identified and defined.

Development and evaluation of a booklet to promote ealthy lifestyle in people with HIV

OBJECTIVE

To develop and evaluate an educational primer to promote healthy lifestyles in people with HIV.

METHODS

Study of technological development in three stages: Development of the booklet, with bibliographical review, illustrations, layout, diagramming, adopting as reference the trans-theoretical model of behavior change; Analysis of content and appearance by 22 judges; Semantic analysis by 22 people with HIV. The proportion of positive evaluations of the items was measured, considering a percentage equal to or greater than 85%.

RESULTS

My motivational booklet for change! Practices for promoting a healthy lifestyle" had six areas: Body weight control; Healthy eating; Exercise practice; Smoking, alcohol and other drugs; Stress control; and Drug treatment. Most of the items evaluated agreed with an overall average of 92.4% by the judges and 98.9% by the target audience.

CONCLUSION

The booklet had evidence of adequate validity to be used by people with HIV.

Concept analysis of Perioperative Thirst for the development of a new nursing diagnosis

OBJECTIVES

to analyze the perioperative thirst concept for the development of a new diagnostic structure according to NANDA International.

METHODS

a concept analysis study based on the framework proposed by Walker and Avant, instrumentalized through an integrative literature review based on SCOPUS, CINAHL, PUBMED, LILACS, and WOS. The elaboration of the diagnostic structure followed NANDA International guidelines.

RESULTS

41 studies were analyzed revealing that perioperative thirst is prevalent and intense, having visceral and behavioral attributes as the core of the concept. Antecedents indicate that surgical patients are vulnerable to thirst; and consequents 16 signs and symptoms were organized and model cases were developed. A diagnostic structure has been developed for perioperative thirst.

FINAL CONSIDERATIONS

concept analysis allowed language standardization that describes thirsty patients, helping the identification, planning of actions and communication of perioperative nursing care.

Diagnostic indicators of risk-prone health behaviors in pregnant adolescents

PURPOSE

This study aimed to identify diagnostic indicators associated with the nursing diagnosis risk-prone health behaviors in pregnant adolescents.

METHODS

We conducted a cross-sectional study. The sample consisted of 181 pregnant adolescents. A latent class analysis was conducted to verify associations between the defining characteristics of risk-prone health behaviors and diagnostic accuracy measures. Logistic regression was used to identify factors associated with the manifestation of risk-prone health behavior.

FINDINGS

The prevalence of risk-prone health behaviors in this sample was 31.04%. The defining characteristics failure to take action that prevents health problems and inappropriate eating habits achieved a high sensitivity. The related factors such as insufficient social support, stressors, low self-efficacy, social anxiety, isolated region of residence, and restricted access to health services presented significant associations with risk-prone health behavior.

CONCLUSIONS

The diagnostic indicators associated with the nursing diagnosis of risk-prone health behavior were failure to take action that prevents health problems inappropriate eating habits, insufficient social support, stressors, low self-efficacy, social anxiety, isolated region of residence, and restricted access to health services.

IMPLICATIONS FOR NURSING PRACTICE

This study contributes to knowledge about the diagnostic indicators of risk-prone health behavior, which may help nurses reach the proper diagnosis. This will facilitate the application of clinical judgment in nursing care to assist pregnant adolescents.

The factors related to a sedentary lifestyle: A meta-analysis review

AIMS

To compare factors associated with the sedentary lifestyle described in the literature with the factors listed in NANDA International.

DESIGN

Systematic review with meta-analysis of factors associated with a sedentary lifestyle in adolescents, adults and older people.

DATA SOURCES

An electronic search of PubMed, Scopus, CINAHL and Latin America and the Caribbean Literature on Health and Science databases conducted in May 2016.

REVIEW METHODS

Descriptive data were extracted according to a standardized form. The odds ratios for each etiological factor associated with a sedentary lifestyle were extracted directly from the articles or calculated from the data described therein. The meta-analysis was conducted for factors that were investigated in more than one study.

RESULTS

Thirty-five articles were included. The statistically significant factors were: lack of social support, of physical space, of time, of motivation, of sports skills and of interest in physical activity, intolerance to activity, being retired, living in a low-income country, laziness, not having a job/studying, low socioeconomic status and level of knowledge about physical activity, female gender, living in an urban area, negative self-perception of health, using public transportation, being in the oldest age group in the study and perceived physical disability.

CONCLUSION

The new factors associated with a sedentary lifestyle and those already included in the NANDA International classification will lead to better clinical guidance for nurses.

IMPACT

Knowledge about these factors can contribute directly to public health policies.

Risk for impaired cardiovascular function nursing diagnosis: Content analysis to evaluate women in jail

OBJECTIVE

To analyze the content of the diagnostic proposal, risk for impaired cardiovascular function, focusing on incarcerated women.

METHODS

A methodological study of nursing diagnosis content validation carried out from December/2018 to June/2019. A sample of 24 judges evaluated the proposed definition and the relevance of the proposed etiological factors of risk for impaired cardiovascular function. To determine the content validity of the etiological factors, the Content Validity Index was calculated and a value of 0.9 was adopted, in addition to the Wilcoxon test.

RESULTS

The diagnostic definition was considered consistent with the diagnostic label. All 18 etiological factors were validated with a Content Validity Index statistically >0.9 and categorized into risk factors, associated conditions, and at-risk populations.

CONCLUSION

The definition and 18 etiological factors of risk for impaired cardiovascular function were validated.

IMPLICATIONS FOR THE NURSING PRACTICE

The study allowed the new proposal for the risk for impaired cardiovascular function nursing diagnosis to be accepted to return to the taxonomy of NANDA International with an expanded and more consistent structure. The return of the referred nursing diagnosis to the taxonomy favors the nurse's diagnostic reasoning and the documentation of all nursing actions, linked to this diagnosis, which are aimed at minimizing cardiovascular risk.

Content analysis of nursing diagnoses related to urinary incontinence

OBJECTIVE

To analyze the content of nursing diagnoses related to urinary incontinence according to NANDA International and others identified in the literature.

METHOD

Methodological study conducted with judges who were experts in urinary dysfunctions and nursing diagnosis. The analysis included diagnoses of Stress Urinary Incontinence, Urgency Urinary Incontinence, Functional Urinary Incontinence, Urinary Incontinence due to Neurogenic Detrusor Overactivity (previously denominated Reflex Urinary Incontinence in NANDA International's taxonomy), Mixed Urinary Incontinence, and Transient Urinary Incontinence. Wilcoxon test was applied and Content Validity Index ≥ 0.85 was considered appropriate.

RESULTS

Fifty-one judges participated in this study. The judges recommended modifications in elements of all diagnoses (inclusion, exclusion or change of previous element type).

CONCLUSION

The four diagnoses analyzed in NANDA International's taxonomy are recommended to be maintained with modifications; inclusion of nursing diagnoses Mixed and Transient Urinary Incontinence is also recommended.

Brazilian Nursing Process Research Network contributions for assistance in the COVID-19 pandemic

OBJECTIVE

to describe the theoretical construction process of nursing process support documents in COVID-19 care scenarios.

METHODS

an experience report of the joint activity of the Brazilian Nursing Process Research Network (Rede de Pesquisa em Processo de Enfermagem) composed of Higher Education and Health Institution researchers in Brazil.

RESULTS

five instruments were organized collectively, involving the elements of nursing practice (nursing diagnoses, outcomes and interventions) in assistance for community; for patients (with suspected or mild, moderate, and critical COVID-19 and residents in Nursing Homes); for nursing workers' health support, also subsidizing registration and documentation during the COVID-19 pandemic.

FINAL CONSIDERATIONS

valuing the phenomena manifested by families/communities, patients and health professionals is essential for early detection, intervention, and prevention of diseases.

Analysis of the NANDA-I taxonomy "maternal-fetal dyad" concept in high-risk pregnancy: integrative review

OBJECTIVE

to analyze the NANDA-I taxonomy "maternal-fetal dyad" concept in high-risk pregnancy.

METHOD

an integrative literature review based on the Conceptual Analysis model proposed by Walker and Avant. It was conducted at PUBMED, CINAHL, SCOPUS, LILACS and SciELO, with the descriptors: Complications of pregnancy, Risk Factors, and Pregnancy, High-Risk (from 2008-2020).

RESULT

the sample consisted of 44 articles, which identified two attributes and 21 antecedents of the concept.

CONCLUSION

concept analysis allowed to identify the attributes and antecedents of the "maternal-fetal dyad" concept in high-risk pregnancy, in addition to raising and clarifying ideas. It was possible to identify 12 antecedents that are not included in NANDA-I as well as the need to review the definition of the diagnosis proposed by the taxonomy.

Middle range theory for the nursing diagnosis Excess Fluid Volume in pregnant women

OBJECTIVE

To stablish a middle range theory for the understanding of the causal mechanisms and clinical consequentes of the nursing diagnosis Excess Fluid Volume (00026) among pregnant women.

METHOD

The Middle Range Theory was constructed in five stages: defining of construction approach, establishing main concepts, elaborating propositions, developing a pictorial diagram, and establishing the causal relationships and evidence for practice of the Middle Range Theory.

RESULTS

We identified 14 clinical indicators and 6 causal factors of Excess Fluid Volume. A pictorial diagram was developed and relationships between Excess Fluid Volume elements were established with 6 propositions for them.

CONCLUSION

The Middle Range Theory included both physiological and pathological conditions to explain Excess Fluid Volume. This Middle Range Theory might help in the better understanding of interactions between causal factors and clinical indicators of Excess Fluid Volume.

Anxiety and depression: a study of psychoaffective, family-related, and daily-life factors in celiac individuals

OBJECTIVE

To identify the prevalence of anxiety and depression and its association with psychoaffective, family-related, and daily-life variables of celiac individuals.

METHODS

Crosssectional study, developed with 83 celiac patients in Fortaleza. An instrument was applied with variables grouped in the categories: psychoaffective, family-related, and daily-life.

RESULTS

It was found that 52 celiac patients (62.7%) had anxiety and 29 (34.9%) had depression. The clinical conditions found and the number of symptoms increased the chance of anxiety/depression. The predominant factors in those with anxiety were Lack of control of the celiac disease (98.1%), Perceived clinical condition (75.0%), Daily obstacles for maintaining a gluten-free diet (63.4%), and Daily activities (55.8%). In those with depression, there was a higher prevalence of Lack of control of the celiac disease (100.0%), Perceived clinical condition (82.2%), and Daily obstacles for maintaining a gluten-free diet (69.0%).

CONCLUSION

Celiac individuals with anxiety and depression frameworks presented a higher frequency of Perceived clinical condition, Insufficient social support (psychoaffective factors) and Daily obstacles for maintaining a gluten-free diet (daily-life factor).

Prognostic indicators of short-term survival of ineffective airway clearance in children with acute respiratory infection: a longitudinal study

Background: Studies that establish the indicators of clinical status deterioration of Ineffective airway clearance remain scarce. Prognostic studies provide data for nurses identify clinical indicators that suggest a higher chance of early development of a nursing diagnosis. Objective: To identify the prognostic indicators of short-term survival of ineffective airway clearance (IAC) in children with acute respiratory infection (ARI). Design: A prospective open cohort study. Methods: This study was with a group of 136 children with acute respiratory infection who were followed for a minimum of six and a maximum of ten consecutive days. Children who had not completed six days of monitoring or who were carriers of diseases that would alter the specific symptoms of respiratory infection were excluded. The survival rate of ineffective airway clearance was calculated using Nelson-Aalen's method. A Cox regression model was used to analyze the influence of clinical indicators on survival time of this diagnosis. Results: The diagnosis survival rate was extremely low (only 0.4% on the 5th day of follow-up). The greatest reduction in survival rate was observed in the first 48 h (survival rate = 2.5%). Four defining characteristics associated with a worse prognosis of IAC among children with ARI: ineffective cough (RR = 5.86; 95% CI: 3.53-9.72), absence of cough (RR = 2.92; 95% CI: 1.68-5.08), adventitious breath sounds (RR = 2.47; 95% CI: 2.01-3.03), and diminished breath sounds (RR = 1.23; 95% CI: 1.05-1.45). Conclusion: Four clinical indicators showed a strong relationship with an increased risk of worsening clinical status associated with this nursing diagnosis. Impact statement: Clinical deterioration related to ineffective airway clearance among children with acute respiratory infection is fast and requires particular attention from nurses.

A Middle-Range Theory for Nurses to Diagnose Ineffective Infant Feeding Patterns

PURPOSE

To construct a middle-range theory, based on the Roy adaptation model, for nurses can diagnose an ineffective infant feeding pattern.

DATA SOURCE

Scientific findings were used through a literature review and the concepts of the Roy model.

DATA SYNTHESIS

The theory indicated new elements for the diagnosis: 12 etiological factors and 13 clinical indicators. Most of those are not contained in the NANDA taxonomy.

CONCLUSION

The middle-range theory for these diagnoses highlights the need for a review of the components present in the taxonomy.

IMPLICATIONS FOR NURSING PRACTICE

This approach guides research on nursing diagnoses to revise the content of the theory and to expand its concepts and elements for the diagnosis of an ineffective infant feeding pattern.