Validación del contenido diagnóstico de la etiqueta diagnóstica enfermera “sedentarismo”

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.

The connection between nursing diagnosis and the use of healthcare resources

AIM

The health service invests up to 75% of its resources on chronic care where the focus should be on caring rather than curing. Nursing staff focuses their work on such care. Care requires being redorded in health histories through the standardized languages. These records enable useful analyses to organisational and healthcare decision-making. Our proposal is to know the association of between nursing diagnosis and a higher total expenditure on health.

METHOD

An observational cross-sectional analytical study was performed based on data from electronic health records in Primary Care (Drago-AP), hospital discharges (CMBD-AH) and prescriptions (REC-SCS) of patients over 50 from 2012-2013 in the Canary Islands. A descriptive, bivariate and multivariate analysis was undertaken to create a predictive model on the use of resources.

INDEPENDENT VARIABLES

Sociodemographic (age, sex, type of health-care affiliation, type of prescription charge) and nursing diagnosis (ND) recorded in late 2012. Dependent variables: Resources consumed in 2013.

RESULTS

582,171 patients met the criteria for inclusion. 53.0% of them were women with an average age of 64.3 years (SD 10.8years). 53.2% were pensioners. 49% of the included population had an ND, with an average of 2.1ND per patient. The average costs per patient were 1824.62€ (with a median of 827.5€) 25 and 27 percentiles of 264.1€ and 1824.7€, respectively. The bivariate analysis showed a significant correlation between these expenses and all the demographic variables; the expenses increased when a nursing diagnosis has been made (Spearman's rank=0.37: the more diagnoses, the more expenses). In the multivariate analysis, a first linear regression with the sociodemographic variables as independent variables explains 13.7% of the variability of the logarithm of the full costs (R²=0.137). If we add to this model the presence of nursing diagnoses, the explanatory capacity reaches 19.77% (R²=0.1977).

CONCLUSION

Compared with a model that only consists of sociodemographic variables, nursing diagnoses can enhance the explanatory capacity of the use of healthcare resources.

Estilo de vida sedentário em indivíduos com hipertensão arterial

RESUMO Objetivo: identificar a prevalência do diagnóstico de enfermagem Estilo de Vida Sedentário (EVS) e analisar sua associação com os indicadores clínicos (IC) e fatores relacionados (FR) em indivíduos com hipertensão arterial (HA). Método: estudo transversal com 285 pacientes com HAS em um centro de referência em atendimento ambulatorial no nordeste do Brasil. Para a coleta de dados, utilizou-se instrumento baseado nas definições operacionais dos IC e FR validados anteriormente. Quatro enfermeiros classificaram EVS como presente ou ausente. Para avaliar a associação entre IC e FR com a presença de EVS aplicou-se o Teste de Qui-quadrado. Calculou-se a razão de prevalência e intervalo de confiança para verificar a magnitude do efeito entre FR e EVS. Resultados: identificou-se EVS em 55,8% da amostra. Cinco IC e seis FR apresentaram associação estatística significante com EVS. Conclusão: o estudo identificou os principais indicadores para inferência de EVS, bem como seus possíveis fatores causais entre pessoas com HAS.

Clinical Validation of the “Sedentary Lifestyle” Nursing Diagnosis in Secondary School Students

This study clinically validated the nursing diagnosis of “sedentary lifestyle” (SL) among 564 Brazilian adolescents. Measures of diagnostic accuracy were calculated for defining characteristics, and Mantel–Haenszel analysis was used to identify related factors. The measures of diagnostic accuracy showed that the following defining characteristics were statistically significant: “average daily physical activity less than recommended for gender and age,” “preference for activity low in physical activity,” “nonengagement in leisure time physical activities,” and “diminished respiratory capacity.” An SL showed statistically significant associations with the following related factors: insufficient motivation for physical activity; insufficient interest in physical activity; insufficient resources for physical activity; insufficient social support for physical activity; attitudes, beliefs, and health habits that hinder physical activity; and insufficient confidence for practicing physical exercises. The study highlighted the four defining characteristics and six related factors for making decisions related to SL among adolescents.

Nursing diagnosis of sedentary lifestyle: expert validation

This study's aim was to verify with experts the appropriateness of the components (definition, defining characteristics and related factors) of the nursing diagnosis sedentary lifestyle for individuals with hypertension. The validation process took place from February to July 2011, by 48 nurse specialists in nursing terminologies and/or sedentary lifestyle and/or hypertension. Based on this study, changes in the definition of Sedentary Lifestyle and in the titles of five indicators are recommended, in addition to the addition of another six related factors and three defining characteristics to the list of the NANDA-International Taxonomy II. The process of expert validation enables improvement and more reliable and accurate identification of clinical indicators with greater diagnostic accuracy.

Risk for decreased cardiac output: validation of a proposal for nursing diagnosis

AIM

To verify the content validity of the nursing diagnosis risk for decreased cardiac output (RDCO).

BACKGROUND

DCO is a phenomenon that is not restricted to individuals or environments that specifically focus on cardiovascular care. It is not only prevalent in cardiovascular care units, but also in post-anaesthesia units and non-cardiac care units among individuals with non-cardiogenic disorders. A significant decrease in cardiac output is a life-threatening situation, demonstrating the need for developing a risk nursing diagnosis for early intervention. The development of this diagnosis requires the construction of a diagnosis label, a definition of the diagnostic concept and the risk factors associated with the diagnosis.

METHODS

The research was carried out in two methodological stages based on the Fehring diagnosis content validation model. The quantitative analysis consisted of the calculation of the weighted mean of the values attributed by experts to each risk factor, the level of agreement/disagreement between the experts regarding the operational definitions of risk factors and the index of diagnostic content validity (DCV).

RESULTS

The label 'risk for decreased cardiac output' was considered representative of a nursing diagnosis defined as 'at risk of developing a health status characterized by an insufficient quantity of blood pumped by the heart to meet physical metabolic demands'. Critical risk factors (DCV ≥ 0·7) were myocardial dysfunction (0·887), blood loss (0·875), increase in intrapericardial pressure (0·825), condition that leads to changes in cardiac rhythm and/or electrical conduction (0·812), deficient fluid volume (0·725), plasma loss (0·712), ineffective tissue perfusion (0·712) and electrolyte imbalance (0·7).

CONCLUSIONS

The research identified eight risk factors with valid content for assessment of RDCO.

IMPLICATIONS FOR NURSING PRACTICE

The identification of risk factors for DCO assists nurses to intervene early and minimize the consequences of a deficient cardiac function.

Prevalence of sedentary lifestyle in individuals with high blood pressure

OBJECTIVE

To identify the prevalence of a sedentary lifestyle in individuals with high blood pressure.

METHODS

This cross-sectional study was conducted among 310 individuals with high blood pressure.

RESULTS

The prevalence of the diagnosis of sedentary lifestyle was 60%. The more common defining characteristics were "lack of physical conditioning" and "lack of practice for physical exercises." The nursing diagnosis was associated with age and presence of diabetes. Individuals who presented with a sedentary lifestyle related to lack of motivation were significantly younger.

CONCLUSIONS

This study showed a high prevalence of "sedentary lifestyle" and its associations with age and the presence of diabetes. IMPLICATIONS TO NURSING PRACTICE: The acknowledgement of "sedentary lifestyle" contributes to the choice for nursing interventions that promote physical activity centered on the subject and the surroundings.

[Structured review of physical activity measurement with questionnaires and scales in older adults and the elderly]

OBJECTIVE

To characterize the distinct questionnaires and scales used to measure physical activity, their conceptual frameworks, psychometric properties and application norms.

METHOD

The review included original articles that used questionnaires or scales to assess physical activity in older adults or the elderly. The CINAHL and MEDLINE databases were consulted for the years 1993 to 2007. The studies selected had to provide information on the use, development and psychometric properties of the instruments. Instruments used in the population aged more than 45 years old were included. Articles that assessed physical activity by direct estimation, complex methods, or physical performance were excluded.

RESULTS

The search produced 166 references and 36 instruments were identified. Most of the studies quantified physical activity, and a minority assessed self-efficacy in physical activity performance and the stage of change. Half of the instruments were self-administered. The most frequently studied reliability was test-retest. Criterion validity was studied in 14 instruments, and 11 of these used at least two alternative methods of measurement. Construct validity was assessed in 26 instruments. Responsiveness was evaluated in only three instruments (YPAS, CHAMPS and Exercise Stage of Change) in addition to reliability and validity.

CONCLUSIONS

The Exercise Stage of Change questionnaire showed responsiveness and sufficient reliability to allow individual use. The 7Day PAR questionnaire and the Modified Baecke Questionnaire (Spanish version), which evaluate physical activity, can be used on an individual basis, although their responsiveness has not been studied. In general, the instruments analyzed do not assess mild intensity activities.

[Quality of life in homebound elderly people in a district of Alicante (Spain)]

OBJECTIVE

To measure health-related quality of life (HRQoL) in homebound elderly individuals in the District of San Blas (Alicante, Spain).

METHOD

The sample was composed of 107 people aged more than 75 years old included in the home care program. As a measurement instrument, the Spanish version of COOP/WONCA charts in their complete version were used.

RESULTS

The mean age was 83.18 years. Distribution by sex was 76 (71%) women and 31 (29%) men. The mean overall score was 29.7 points with a standard deviation of 5.04. The association between age and total score was 0.19, which was statistically significant (p = 0.045). Comparison of these two means with Student's t-test for independent samples showed no statistically significant differences (t = -580; p > 0.05). When differences between men and women in each of the items of the scale were analyzed, only "social activities" showed a statistically significant difference (t = -2.959; p = 0.04). The time taken to administer the questionnaire was 30 +/- 5 min.

CONCLUSIONS

HRQoL in our population is worse than that in other studied populations. Due to the ceiling-floor effect of some of the variables, further studies in this type of population are required. The time used in this type of population to complete the questionnaire was five times greater than that used in other populations.

The Expert Nurse Profile and Diagnostic Content Validity of Sedentary Lifestyle: The Spanish Validation

PURPOSE

To identify the diagnostic content validity of Sedentary Lifestyle and to identify the expert nurse profile in validating this nursing diagnosis in the Spanish cultural context.

METHODS

Fehring's Diagnostic Content Validity (DCV), the factorial validity of the defining characteristics, the analysis of convergent validity, and the expert profile were assessed.

FINDINGS

The DCV index for experts was .70. The factorial validity showed two different factors: the expression of laziness and the performance of activities of daily living. On the expert profile related factors analysis, two factors, experience and education, were identified.

CONCLUSIONS

The DCV for Sedentary Lifestyle was high among the expert nurses. A nurse was considered to be an expert who was able to accurately answer the four labels identified as nursing diagnoses, had read at least one nursing process article in the past year, and was able to list three nursing process reference books.

IMPLICATIONS FOR PRACTICE

Clarifying the manifestations of sedentary lifestyle will assist clinical nurses in determining this diagnosis, and the expert profiles will assist in the selection of participants for content validity studies.