Validação diferencial dos diagnósticos de enfermagem memória prejudicada e confusão crônica

Abstract

Introduction - The difficulty to establishing clinical criteria for identification of the Nursing Diagnosis (ND) Impaired Memory (IM) and the Chronic Confusion (CC), due to the similarities between some Defining Characteristics (DC) and Related Factors (RF) led to the formulation of objectives: to validate the diagnostics proposed at NANDA-I, IM and CC, by validation of the differential diagnostic; to analyze the diagnoses IM and DC by way of the integrative review of literature; to analyze the DC, RF, as well as the relevance of titles, concepts and the order proposed for NDIM and CC by NANDA-I, through the analyzes by experts. Method - quantitative study, with the use of the Hosking and Fehring's methodological proposals developed in three stages. At first, the conceptual analysis was developed by means of an integrative review. The descriptors that were used: nursing diagnoses, impaired memory, chronic confusion, nursing diagnosis and the same words in Portuguese. In the second stage, validation of diagnostic content, the study had 31 nurses that answered the questionnaire for analysis of the differential criteria NDIM and CC, routed to 249 experts in several Brazilian states, with a score equal or higher than 6. The data analysis was proceeded by statistical, descriptive and inferential mode. In the third stage, the validation of differential diagnostic was developed by matching the replies of overall average, with the Wilcoxon test. The study was approved by the Ethics in Research and the willingness of the experts upon signature of the term of free and informed consent. Results - 30 articles were analyzed, 15 (50%) of them were characterized as observational study. About the distribution between the two ND, 5 (16.7%) of articles were directed toward IM, 4 (13.3%) to the CC, and 21 (70.0%) treated to both diagnosis, giving an evidence of similarity. For the NDIM were identified two DC as main: “inability to determine if an action was performed”, with score of 0,86 and “inability to learn new skills” (0,89). Between the RF, three were considered secondaries: “neurological disturbances”, “hypoxia” and “decreased cardiac output”, 0,78, 0,70 and 0,66 and none primary RF. In NDCC there was none principal DC, the majority (8) remained with scores between 0,79 and 0,63, and 2 with values lower than these: “clinical evidence of organic impairment”, with score of 0,57 and 0,46 for “no change in level of consciousness”. Between the RF, in a total of five, three RF obtained main scores: “cerebral vascular attack”, 0,83, “multi-infarct dementia” 0,81, and the last one, “Alzheimer's disease” 0,81. Conclusion - the results showed little specificity for these diagnoses, what strengthening the null initial hypothesis, with the absence of significant differences between the DC and the RF of NDIM and CC. The similarities identified by nurses confirmed the results of the integrative review and also reenforcing the obtained data in validation of differential diagnostic. It concludes that the provision within the NANDA-I is adequate, because such diagnostics are related to the relevance to the standard function, where they are inserted. Even so, some changes on titles and concepts may be necessary, as well as, new studies will be indispensable for this new diagnostic wording.