Ineffective breathing pattern in children and adolescents with congenital heart disease: accuracy of defining characteristics

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.

Teoria de Médio Alcance do Padrão Respiratório Ineficaz em Crianças com Cardiopatia Congênita

Resumo Objetivo: desenvolver e avaliar uma teoria de médio alcance para o Diagnóstico de Enfermagem de Padrão Respiratório Ineficaz em crianças com cardiopatia congênita. Método: um estudo metodológico realizado em duas etapas: 1) desenvolvimento de uma teoria de médio alcance para padrão respiratório ineficaz em crianças com doenças cardíacas congênitas a partir da análise da taxonomia NANDA-Internacional, modelo de adaptação de Callista Roy e uma revisão da literatura; e 2) avaliação da teoria de médio alcance desenvolvida por meio da avaliação de painéis de especialistas. Resultados: após três avaliações de painéis, a versão final da teoria de médio alcance resultou em quatro metaparadigmas, dois conceitos-chave, dois diagramas pictóricos, duas propostas e uma descrição das inter-relações entre os conceitos-chave do Padrão Respiratório Ineficaz em crianças com cardiopatias congênitas e evidências para a prática de Enfermagem. Conclusão: a teoria do médio alcance desenvolvida e avaliada por especialistas identificou estímulos e comportamentos que podem auxiliar os enfermeiros na identificação das razões pelas quais o Padrão Respiratório Ineficaz é diagnosticado e como ele se manifesta em crianças com cardiopatia congênita, aumentando a compreensão das relações entre as causas e sua temporalidade.

Middle-Range Theory of Ineffective Breathing Pattern in children with Congenital Heart Disease

OBJECTIVE

to develop and evaluate a middle-range theory for the Nursing Diagnosis of Ineffective Breathing Pattern in children with congenital heart disease.

METHOD

a methodological study carried out in two stages: 1) development of a middle- range theory for Ineffective Breathing Pattern in children with congenital heart diseases from the analysis of the NANDA-International taxonomy, Callista Roy's Adaptation Model and a literature review; and 2) assessment of the middle-range theory developed using expert panel evaluation.

RESULTS

after three panel evaluations, the final version of the middle-range theory resulted in four metaparadigms, two key concepts, two pictorial diagrams, two propositions and a description of the interrelationships between the key concepts of Ineffective Breathing Pattern in children with congenital heart diseases and evidence for the Nursing practice.

CONCLUSION

the middle-range theory developed and evaluated by experts identified stimuli and behaviors that can assist nurses in identifying the reasons why Ineffective Breathing Pattern is diagnosed and how it manifests itself in children with congenital heart disease, increasing understanding of the relationships between the causes and their temporality.

Teoría de Mediano Alcance del Patrón de Respiración Ineficiente en niños con cardiopatías congénitas

Resumen Objetivo: desarrollar y evaluar una teoría de mediano alcance para el Diagnóstico de Enfermería “Patrón de Respiración Ineficiente” en niños con cardiopatías congénitas. Método: estudio metodológico desarrollado en dos etapas: 1) Desarrollo de una teoría de mediano alcance para el Patrón de Respiración Ineficiente en niños con cardiopatías congénitas a partir del análisis de la taxonomía NANDA-Internacional, del Modelo de Adaptación de Callista Roy y de una revisión de la literatura; y 2) Evaluación de la teoría de mediano alcance desarrollada por medio de una evaluación de un panel de expertos. Resultados: después de tres evaluaciones a cargo del panel, la versión final de la teoría de mediano alcance derivó en cuatro metaparadigmas, dos conceptos clave, dos pictogramas, dos propuestas y una descripción de las interrelaciones entre los conceptos clave del Patrón de Respiración Ineficiente en niños con cardiopatías congénitas y evidencia para la práctica de Enfermería. Conclusión: la teoría de mediano alcance desarrollada y evaluada por expertos identificó estímulos y comportamientos que pueden ayudar a los enfermeros a identificar los motivos por los cuales se diagnostica el Patrón de Respiración Ineficiente y cómo se manifiesta en niños con cardiopatías congénitas, mejorando así la comprensión de las relaciones entre las causas y su temporalidad.

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.

A Content Analysis of Clinical Indicators of the Nursing Diagnosis Ineffective Breathing Pattern

PURPOSE

To verify the relevance of the clinical indicators, the clarity and precision of the conceptual, and operational definitions for Ineffective breathing pattern (IBP).

METHODS

A content analysis by 39 judges.

FINDINGS

The results showed 28 clinical indicators for IBP. However, only seven were not considered relevant for the diagnosis. These are not listed in NANDA International taxonomy. All conceptual and operational definitions were adequate, according to the analysis of the judges.

CONCLUSION

The list of 28 clinical indicators of IBP was submitted for analysis by judges, which then resulted in the validation of 21 of these elements.

IMPLICATIONS FOR NURSING PRACTICE

This study clarifies that gaps in the structure of diagnoses, helping nurses' diagnostic reasoning process in clinical practice.

Defining characteristics and related factors of the nursing diagnosis for ineffective breathing pattern

OBJECTIVE

To identify in the literature the defining characteristics and related factors of the nursing diagnosis "ineffective breathing pattern".

METHOD

Integrative review with the steps: problem identification, literature search, evaluation and analysis of data and presentation of results.

RESULTS

Twenty articles and two dissertations were included. In children, the most prevalent related factor was bronchial secretion, followed by hyperventilation. The main defining characteristics were dyspnea, tachypnea, cough, use of accessory muscles to breathe, orthopnea and adventitious breath sounds. Bronchial secretion, cough and adventitious breath sounds are not included in the NANDA-International (NANDA-I). For adults and older adults, the related factors were fatigue, pain and obesity and the defining characteristics were dyspnea, orthopnea and tachypnea.

CONCLUSION

This diagnosis manifests differently according to the patients' age group. It was observed that some defining characteristics and related factors are not included in the NANDA-I. Their inclusion can improve this nursing diagnosis.

Clinical Differentiation of Respiratory Nursing Diagnoses among Children with Acute Respiratory Infection

The aim of this study was to identify the defining characteristics that allow clinical differentiation of the nursing diagnoses, ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE). A secondary analysis with a cohort design was developed from 1128 records obtained during the hospital stay of 136 children with acute respiratory infection. Groups of defining characteristics with greater differentiation capacity were identified by multiple correspondence analyses. The results showed that the defining characteristics that better differentiate the studied diagnoses are agitation, irritability and diaphoresis for IGE; dyspnea, use of accessory muscles to breathe, orthopnea, and abnormal breathing pattern for IBP and excessive sputum, absence of cough, difficulty verbalizing, nasal flaring, and adventitious breath sounds for IAC. Twelve defining characteristics that can assist clinicians to differentiate the three main respiratory nursing diagnoses among children with acute respiratory infection were identified in this study.

Diagnósticos de Enfermagem em crianças com cardiopatias congênitas: mapeamento cruzado

Resumo Objetivo Identificar Diagnósticos de Enfermagem da NANDA International a partir dos termos encontrados nos registros de Enfermagem de crianças com cardiopatias congênitas hospitalizadas e verificar associação entre estes termos e os Diagnósticos de Enfermagem mapeados. Métodos Estudo observacional, transversal desenvolvido por mapeamento dos termos nos registros de Enfermagem de crianças hospitalizadas de até 2 anos com cardiopatia congênita. A associação entre os termos e os Diagnósticos de Enfermagem mais frequentes foi avaliada pelo teste t de Student ou qui quadrado. Resultados Nos 82 registros analisados, os Diagnósticos de Enfermagem mais frequentes foram Risco de infecção (81,7%), Troca de gases prejudicada (46,3%) e Intolerância à atividade (36,6%). O termo “cianótico” e “hipocorado” tiveram relação estatisticamente significativa com o diagnóstico Troca de gases prejudicada. Conclusão Observou-se que os termos registrados em prontuários de crianças com cardiopatias congênitas permitiram a identificação dos Diagnósticos de Enfermagem da NANDA International, além da verificação das associações.