Validation of Anxiety by Brazilian Nurses

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  • PURPOSE. To examine the prevalence of nursing diag-noses among hospitalized patients with congestive heartfailure (CHF).

    METHODS. Patients in the cardiology unit with a diag-nosis of CHF types IIV (N = 26) were surveyed using aninvestigator-developed data collection tool to determinethe nursing diagnoses common to this patient population.

    FINDINGS. Activity intolerance was present in 100% ofpatients regardless of severity of CHF. Fluid volume excess

    International Journal of Nursing Terminologies and Classifications Volume 14, No. 4 Supplement, October-December, 2003 1

    was present in 79% of patients with types I and II, and in92% with types II and IV. Sleep pattern disturbance oc-curred in 80% with types I and II, and in 90% with typesII and IV.

    CONCLUSIONS. CHF is considered a syndrome hav-ing several signs and symptoms, which evidences theneed for language standardization and systematic nurs-ing assistance.

    Author contact [Assis]:

    Presented Papers: Nursing Diagnosis

    Nursing Diagnoses in Patients With Congestive Heart Failure

    Cinthia Calsinski de Assis and Alba Botura Leite de Barros

    PURPOSE. To explore and identify diagnostic compo-nents to amplify NANDA nursing diagnoses by modi-fying the root violence. Whereas violence is nondebat-able as a diagnostic concept in nursing, otheralternatives have not been identified in the two existingdiagnoses.

    METHODS. Using the case study method, this qualita-tive study sought to identify commonalties in a popula-tion of women who were donnas da casa (homemak-ers) in a small rural community of approximately 100families, typical of the Brazilian northeast. The sample of7 women was identified through a larger study that hadbeen based on health needs of the community. Data wereobtained through observation during a home visit and asemistructured interview based on NANDA TaxonomyII. Observations were focused on hygiene, manner ofdress, home environment, and physical and emotionalstate. Data were analyzed by content and clustered intomajor categories. From these a profile of the women andanother of the partners emerged.

    FINDINGS. Subjects ranged in age from 33 to 43 years,and number of children between 3 and 7. One of the 7women was literate; 5 were underweight; all wereslovenly attired. They appeared sad and older than theirage. The majority seemed relieved to unburden them-selves to the interviewers as they went through a gamutof emotions such as sadness, anguish, and irritability ex-pressed through crying, restlessness, changes in bodylanguage, and tone of voice. The shortage of beds wassupplemented by hammocks and mats or cardboard.

    The women spoke of being confined to their home andof male partners who drank on weekends, thus leavingthem with little money for necessities of life. There wereaccounts of beatings when the partner returned homeafter drinking, overt nonacceptance of children from pre-vious marriages, and general destruction of the familyenvironment. New children were regarded as just an-other mouth to feed.

    DISCUSSION. The profiles pointed to the necessity ofidentifying a new nursing diagnosis that would belinked, only tangentially, by the root violence to the twodiagnoses in NANDA Taxonomies I and II. This insightled us to consider that a new method of listingNANDA diagnoses, by root only, is imperative in theevolution of Taxonomy II. Proposed descriptors, Vic-tims of (Axis 3) and Domestic (Axis 6) would be identi-fied by Axes, thereby facilitating the process of classify-ing in the Domains and Classes. The two existingNANDA diagnoses, risk for other-directed violence andrisk for self-directed violence, are proposed for classifica-tion in Class 3, Violence, in Domain 11 of Taxonomy II.Safety/Protection could, by virtue of their modificationpower, find anchor in another domain such as Domain6, Self-Perception.

    CONCLUSIONS. Although Safety/Protection seemsthe most logical domain for classification by root, theaxes, dimensions of human responses, could pull the di-agnosis in another direction, thereby dictating othernursing interventions and nursing outcomes

    Author contact [Coler]:

    Victims of Domestic Violence: A Proposal for a Community Diagnosis Based on One of Two Domains of NANDA Taxonomy II

    Patricia Serpa de Souza Batista, Fernanda Maria Chianca da Silva, Estella Maria Leite Meirelles Monteiro, and Marga Simon Coler

  • Fatigued Elderly Patients With Chronic Heart Failure

    Anna Ehrenberg and Inger Ekman

    PURPOSE. To compare descriptions of fatigue basedon the NANDA characteristics from interviews with el-derly people with congestive heart failure (CHF) anddata recorded by nurses at a Swedish outpatient heartfailure clinic.

    METHODS. Patients were screened for moderate to se-vere CHF. A total of 158 patients were interviewed usinga revised form of the Fatigue Interview Schedule (FIS)based on the NANDA characteristics. Of these patients,half (n = 79) were offered visits at a nurse-monitoredheart failure clinic. Nursing documentation of fatigue at

    the heart failure clinic was reviewed based on theNANDA characteristics and compared with the contentin the patient interviews.

    FINDINGS. Tiredness was documented in 43 (75%)records and indicated in 36 patients based on patientscores on the FIS (X = 5.5; range 1 9). The most fre-quently recorded observation related to fatigue was thesymptom emotionally labile or irritable, followed bynotes on lack of energy and decreased performance. Pa-tients descriptions of their fatigue were expressed as adecreased ability to perform and a perceived need for

    Presented Papers: Nursing Diagnosis

    Nursing Diagnosis Extension and Classification: Ongoing Phase

    Martha Craft-Rosenberg and Saovaluck Jirathummakoon

    BACKGROUND. The Nursing Diagnosis Extensionand Classification Project (NDEC) has been active for al-most a decade. The team began with the formation of ateam of investigators at The University of Iowa Collegeof Nursing. From 1994 until 2000 the research team con-sisted of 16 investigators who were experts in nursingcare across the lifespan. They also represented expertisein both qualitative and quantitative research. The aims ofthe NDEC research are to evaluate and revise NANDAdiagnoses, to validate the diagnoses using a clinical in-formation system, and to develop candidate diagnoses.

    MAIN CONTENT POINTS. Phase 1 of the NDEC re-search has yielded 116 refined and developed nursing di-agnoses that have been submitted to NANDA. Of these,65 have been approved and 54 appeared in Nursing Di-agnoses: Definitions and Classification, 19992000 alongwith 39 NDEC products. In the 20002001 edition, 7 di-agnoses refined by NDEC and 7 new diagnoses submit-ted by NDEC are included.

    As only about half the NDEC products have appearedin NANDA publications, the three-level review process (Di-agnosis Review Committee, membership, and Board) hasbeen discussed with the NANDA board. This request iscurrently being honored by the Diagnosis Review Commit-tee; however, review by the membership and review by theNANDA board is just beginning to move in this direction.

    Phase 2, clinical validation of the NDEC work, isbeing conducted at a long-term care facility. It will alsobe conducted at a large teaching hospital. All the NDECrefinement and development work has been submitted

    for clinical validation. Currently validation is planned atthe label level only.

    Phase 3 involves identification of candidate diag-noses. Many of the candidate diagnoses were developedduring the concept analysis phase, when NDEC teammembers identified the need for additional diagnoses.Nurses in practice have submitted other candidate diag-noses. In total 195 candidate diagnoses have been identi-fied and placed into a database.

    In order for the NDEC team to make decisions regard-ing priorities for diagnosis development, the diagnosesin the candidate database are compared to diagnoses inother classifications that have already been developed.Several classifications are used for comparison includingthe Omaha System and the Home Health Care Classifi-cation. A large table is used to compare candidate labelto other labels. Candidate diagnosis included in otherclassifications will be given lower priority for develop-ment by NDEC.

    CONCLUSIONS. The NDEC work plan includes workon diagnoses to be resubmitted to the NANDA Diagno-sis Review Committee. It is hoped that the Web site forNLINKS will facilitate the work of diagnosis refinementand development. NDEC will continue to work with anyinvestigator who is seeking assistance. The last part ofthe work plan is resource acquisition and recruitment ofinvestigators to continue the refinement and develop-ment of diagnoses.

    Author contact [Craft-Rosenberg]

    2 International Journal of Nursing Terminologies and Classifications Volume 14, No. 4 Supplement, October-December, 2003

  • Presented Papers: Nursing Diagnosis

    additional energy. Results indicated poor concordance inpatients descriptions and record content concerning fa-tigue. Whereas patients emphasized the physical charac-teristics of fatigue, nurses emphasised the emotional fea-tures. Decreased libido was linked to fatigue accordingto the patients but not according to the nurses records.Whereas cognitive characteristics of fatigue occurredrarely in the records, they were more frequent in the pa-tient interviews.

    DISCUSSION. Symptoms such as irritability and acci-dent-proneness may be seen as manifestations of the pa-tients experiencing the need for more energy or a feelingof decreased performance. These consequences of beingfatigued, rather than the different dimensions of fatigue,

    International Journal of Nursing Terminologies and Classifications Volume 14, No. 4 Supplement, October-December, 2003 3

    seemed to have been easy for the nurses to observe anddocument. Earlier studies indicate that poor observation,medication, and diet in patients with heart failure mightpartly be explained by cognitive impairment.

    CONCLUSIONS. Findings of this study highlight theneed for nurses to pay attention to the experience of fa-tigue in patients who suffer from CHF, and to validatetheir observations with the patients own expressions.Using the patients words and expressions and the diag-nostic characteristics of fatigue in recording can supportthe nurses in developing both understanding of patientsliving with CHF and strategies to help patients copewith their restricted ability in daily life.

    Author contact [Ehrenberg]:

    Environmental Nursing Diagnoses: A Proposal for Further Development of Taxonomy II

    Pauline M. Green, Laura V. Polk, and Diann S. Slade

    BACKGROUND. The authors proposed a need for Tax-onomy II to include more environmental nursing diag-noses at the 14th Biennial Conference on Nursing Diag-nosis. Currently, Nursing Diagnoses: Definitions andClassification, 20012001 (NANDA, 2001) lists three diag-noses that focus on the environment: impaired environ-mental interpretation syndrome, risk for poisoning, andlatex allergy response. As communities, nations, and ge-ographic regions experience environmental health prob-lems on individual, local, national, and global levels,nurses need to take an active role in assessing, diagnos-ing, and treating clients who experience environmentalhealth effects of pollution, contamination, and poisoning.It is logical, therefore, to now examine the concept of en-vironment and its linkages with health in order to pro-vide a blueprint for further development of environmen-tal nursing diagnoses and expansion of Taxonomy II.

    MAIN CONTENT POINTS. Nursing theory has givenformal recognition to the importance of the relationshipbetween humans and the environment. The concept ofenvironment has become a well-known component ofthe nursing metaparadigm (Human, Health, Nursing,and Environment), and all the major theorists include anenvironmental component in their conceptual models.However, while nursing literature has formally acknowl-edged that human-environment interaction has an effecton health, theorists have failed to delineate the humanresponses that derive from this interaction. Other disci-plines such as biology and toxicology consider environ-ment as a set of compartmentsair, soil, water, biologi-cal systems and examine the effects that pollutants

    exert on these compartments. Similarly, public healthviews environment as discrete compartments but, in ad-dition, examines the effects pollutants have on individu-als, groups, and society. Sociology has expanded its useof the term environment and now recognizes the com-plex interaction of the natural and social worlds. Anthro-pology also views environment as an emerging area ofstudy that explores how human behavior changes in re-sponse to interaction within the ecosystem.

    The authors again propose that NANDA expand thenumber of environmental nursing diagnoses containedin Taxonomy II and offer the following for considerationand comment. Four major headings will help classify thenursing diagnoses: (a) Individual (specify child or adult),(b) Family, (c) Community/Groups/Aggregates, and (d)Global. Under Individual diagnoses, we propose Ac-tual/Risk for Poisoning (specify type); Actual/Risk forPesticide Contamination (specify type: pesticide, house-hold, industrial); Actual/Risk for Adverse ReproductiveCapacity (specify male or female; causative agent [ethy-lene oxide, antineoplastic drugs, ionizing radiation]; Ac-tual/Risk for Pollution (specify type: air, water, soil, orbiological systems). Under Family diagnoses, we pro-pose Actual/Risk for Solid Waste Contamination (spec-ify type: trash, raw sewage); Actual/Risk for Indoor Pol-lution (specify type: tobacco, radon, pesticides, noise,lead, water); Actual/Risk for Outdoor Pollution (specifytype: aerosol or applied pesticides, noise, exhaust fumes).Diagnoses listed under individual are also applicable tothe family system. Under Community/Groups and Ag-gregates, we propose Actual/Risk for Community-Wide

  • Presented Papers: Nursing Diagnosis

    Infection (specify type: community-wide, specific groupor aggregate; specify type of infection and infectionsource: food borne, vector borne, zoonosis borne); Ac-tual/Risk for Workplace Environmental Exposure/Con-tamination (specify type of chemical or biological agent).Under Global, we propose Actual/Risk for Transbound-ary Environmental Exposure/Contamination (specifytype: solid waste, trash, sewage, acid rain, nuclear waste;specify originating and receiving countries); Actual/Riskfor Global Spread of Infection (specify type of infection:TB, hepatitis, Ebola virus).

    4 International Journal of Nursing Terminologies and Classifications Volume 14, No. 4 Supplement, October-December, 2003

    Clinical Validation in Spain of Dysfunctional Ventilatory Weaning Response

    Ana M. Gimnez and Pilar Serrano Gallardo

    CONCLUSIONS. As nursing develops a greater appre-ciation for the health burden of environmental exposures,the profession can look to NANDA to offer leadership inthe a...


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