Diagnostic Content Validity Research Articles

Concept Analysis and Validation of the Nursing Diagnosis, Delayed Surgical Recovery

To analyze the human response of delayed surgical recovery, approved by NANDA-I, and to validate its defining characteristics (DCs) and related factors (RFs). This was a two-part study using a concept analysis based on the method of Walker and Avant, and diagnostic content validation based on Fehring's model. Three of the original DCs, and three proposed DCs identified from the concept analysis, were validated in this study; five of the original RFs and four proposed RFs were validated. A revision of the concept studied is suggested, incorporating the validation of some of the DCs and RFs presented by NANDA-I, and the insertion of new, validated DCs and RFs. This study may enable the extension of the use of this diagnosis and contribute to quality surgical care of clients.

Validation of defining characteristics for the nursing diagnosis of fatigue in oncological patients

The objective of this study was to validate the defining characteristics for the nursing diagnosis of Fatigue in adult oncological patients. It is a cross-sectional, descriptive study with a quantitative perspective, and its type is diagnostic content validation. Data collection was carried out in a University Hospital. The sample was made up of 35 expert nurses. The instrument used was subdivided into four parts. The data was analyzed by descriptive statistics. 15 defining characteristics were identified, considered secondary indicators. With an average weighting of less than 0.50, four defining characteristics were excluded. The defining characteristic Impaired social interaction, added to those described by NANDA-I after review of the literature, was validated with a weighted average of 0.71. It was concluded that the subjectivity of the defining characteristics and the difficulty nurses have in recognizing them influence the identification of this diagnosis.

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

To verify the content validity of the nursing diagnosis risk for decreased cardiac output (RDCO). 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. 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). 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). The research identified eight risk factors with valid content for assessment of RDCO. The identification of risk factors for DCO assists nurses to intervene early and minimize the consequences of a deficient cardiac function.

Content Validation of a Standardized Language Diagnosis by Certified Specialists in Gerontological Nutrition

Validation of the nutrition standardized language assures the language is accurate for use in practice, policy, and research, but few validation studies have been reported. The purpose of this descriptive study was to validate content of all components of the nutrition diagnostic term involuntary weight loss using experts providing care for older adults in health care settings. A Nutrition Diagnosis Validation Instrument was developed that contained the definition, etiologies, and signs and symptoms of the diagnosis plus items added from literature review. Questions on clarity and completeness of the language were included. The Nutrition Diagnosis Validation Instrument used a Likert-type scale for deriving a Diagnostic Content Validity (DCV) score for all items in the definition, etiology, and signs and symptoms components to define major, minor, and nonrelevant characteristics and a mean total DCV score for the term. In 2008, all Board Certified Specialists in Gerontological Nutrition (CSGs) were recruited by mail. CSGs (n=110, 73% response) reported 15±10 (mean±standard deviation) practice years in gerontological nutrition. The total DCV component scores were 0.80±0.17 (definition), 0.63±0.08 (etiology), and 0.69±0.12 (signs and symptoms). The mean total DCV score of the diagnostic term was 0.69±0.11. Cognitive decline, poor oral health, and impaired skin integrity were identified as missing language. In conclusion, the majority of the definition, etiologies, and signs and symptoms of the term were content-validated, including seven items derived from literature review. The validated items, including recommendations for added language, need to be retested using the same process.

Content Validation of Hopelessness in Slovakia and Czech Republic

The purpose of this study was to validate the content of nursing diagnosis hopelessness in Slovak and Czech social and cultural contexts. The Fehring's Diagnostic Content Validity Model was used to measure the importance of diagnostic characteristics of hopelessness. Only three NANDA characteristics and five Nowotny Hope Scale characteristics have reached the value of weighted average of the scores for defining characteristics. NANDA characteristics are concerned with the affective-behavioral dimension of hopelessness. Nowotny Hope Scale characteristics that reached high importance in our study are concerned with its cognitive-temporal dimension. The defining characteristics of hopelessness identified in our study could be tested in the development of instrument to measure hope in clinical practice.

Content Validation of Nutrition Diagnoses by Members of the Oncology Nutrition Dietetic Practice Group

In Brief Nutrition diagnosis is essential to the nutrition care process. Diagnostic content validation provides evidence diagnoses exist. To validate the content of 22 oncologic diagnoses, a questionnaire was mailed to a random sample of 300 registered dietitians (Oncology Nutrition Dietetic Practice Group members). Each diagnosis had a Nutrition Diagnoses Validation Instrument, which listed the diagnostic label and its components (diagnosis, definition, etiology, and sign/symptom). Participants rated components on a 5-point Likert scale, indicating how fit characteristic each diagnostic label. A diagnostic content validity score (DCVS) and a total DCVS were calculated. All of the definitions achieved DCV scores ≥ 0.80. Thirty-six etiologies and 34.3% of the signs/symptoms were minor. One etiology and sign/symptom scored ≤ 0.50. The total DCV scores for the components ranged from 0.71 to 1.0, indicating that they represented the diagnosis. The diagnoses signify what occurs in practice; however, some refinement may be necessary. Supplemental digital content is available for this article.

Validation of Nutrition Standardized Language Using Fehring Model

The objective of this study was to validate the content of a nutrition diagnostic term, involuntary weight loss, by nutrition experts. A validation instrument, based upon the Ferhing Diagnostic Content Validity Model was developed. Based upon concept analysis of current published literature, 9 additional items were added. Surveys were mailed to Certified Specialists in Gerontological Nutrition (CSG). Diagnostic Content Validity Score (DCV) for each definition, etiology, and sign/symptom were determined. Each item was classified into major characteristics (≥ 0.80), minor characteristics (0.50 to 0.799), or non‐relevant to the diagnosis (below 0.499). Results indicated that 63% of the CSG (n=110) participated. The DCV score was 0.80 ± 0.17 (mean ± SD) for the definition, 0.63 ± 0.08 for the etiologies, and 0.69 ± 0.12 for the signs/symptoms. The mean total DCV score of the diagnostic term was 0.69 ± 0.11. In conclusion, the majority of the definition, etiologies and signs/symptoms were content validated, however the term needs refinement to reflect the seven added items that were validated and to remove the non‐relevant items.Partial funding support was provided by the American Dietetic Association.

A Validation Study of the Nursing Diagnosis Anxiety in Brazil

This study aims to validate the nursing diagnosis of anxiety among expert Brazilian nurses and clinicians using NANDA International defining characteristics and to compare the clinical judgments of the experts and the clinicians. A semistructured questionnaire was completed by a convenience sample of 120 nurses. NANDA International defining characteristics of the Brazilian Portuguese version were used. The analysis of the ratings was based on the framework of the Diagnostic Content Validation model. Brazilian nurses considered the anxiety definition established by NANDA International to be appropriate and experts' and clinicians' judgments were similar for both groups of nurses. The results showed that among the 71 characteristics of anxiety, 8 were identified as critical defining characteristics of anxiety (score >or= 0, 80) by the expert nurses. Brazilian nurses accepted the NANDA International definition for nursing diagnosis of anxiety although some defining characteristics might differ due to cultural differences. Future research could address the limitations of the study and examine validations by both the experts and the clinicians. The adequate preparation of undergraduate and postgraduate nurses in nursing diagnosis is important in improving the quality of care given to patients.

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

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

Content Validation of Parental Role Conflict in the Neonatal Intensive Care Unit

To validate the content of the nursing diagnosis parental role conflict made by neonatal intensive care (NICU) nurses and researchers in the field and to identify the related major and minor defining characteristics.METHOD. Fehring's Diagnostic Content Validation model using 59 neonatal specialists.FINDINGS. Nineteen defining characteristics were validated for use in NICUs: four were considered major and 15 as minor. There was no correlation between nurse profiles and defining characteristic scores.CONCLUSIONS. In this study, parental role conflict was validated for use in neonatal units but defining characteristics must be described in a clearer and more objective manner. Validation studies in different healthcare settings are required so that the specificities of each clientele are met. NANDA diagnoses must be tested and validated at neonatal units, because this setting has developed few studies and their use in practice is a potential way to improve nursing care.

Characteristics of and interventions for fever in Japan

As part of a larger multinational validation study of the International Classification for Nursing Practice (ICNP) alpha version, a survey was conducted in Japan to determine characteristics of 'fever' and interventions to treat febrile patients. Three hundred and fifty-six acute and critical care Japanese nurses participated in this study. The major and minor characteristics of 'fever' perceived by Japanese nurses and interventions used by the nurses in managing febrile patients were identified using the Diagnostic Content Validity (DCV) model. Two characteristics, 'increased body temperature' and 'chills' were selected as major characteristics from the standardized list of the ICNP alpha version validation study. Nine characteristics among the standardized list of characteristics were rated as minor characteristics, and six of the ICNP characteristics were rejected. 'Shivering' and 'infectious lab data' were added with a level of representativeness similar to a major characteristic by nine of the nurses. A variety of interventions to treat fever were reported. The most frequently reported intervention was cooling, followed by warming and medication. Nine dimensions were derived from all reported interventions. As well as perceived characteristics of fever, these interventions may have aspects unique to Japanese nursing practice and to the acute and critical care settings. These results can be compared to those of other populations in future studies.

Validation of Anxiety by Brazilian Nurses

PURPOSETo validate the nursing diagnosis of anxiety as applied by expert Brazilian nurses and clinicians using the NANDA defining characteristics translated into Portuguese, and to compare their judgment.METHODSA descriptive, exploratory, and comparative study was conducted using the Diagnostic Content Validation (DCV) model. A convenience sample of 120 nurses familiar with nursing diagnoses answered a semistructured questionnaire that included demographic data, the definition, and a list of defining characteristics of anxiety. Three defining characteristics of the nursing diagnosis fear were added to the list as distractors. Subjects were asked to rate each defining characteristic on a scale from 1 (not at all characteristic) to 5 (very characteristic). Descriptive analysis was used to identify the nurse experts and clinicians. Assigned weights were determined for each characteristic: 1 = 0, 2 = 0.25, 3 = 0.50, 4 = 0.75, and 5 = 1. Variance analysis using F statistics to compare averages and chi‐squares for frequency distribution were applied. The defining characteristics with weight ratios >.80 were considered critical, those with weight ratios >.50 and <.80 were noncritical, and those defining characteristics with weight ratios of <.50 were not considered representative. An overall DCV score was obtained by summing individual scores and dividing by the total number of defining characteristics. Comparative analysis was used to verify differences in expert and clinician judgments using significant differences analysis.FINDINGSAmong 120 nurses, 51 (44%) were expert nurses and 69 (58%) had expertise by caring for people with anxiety. Three fourths (76%) of the expert nurses and 75% of the clinicians considered the NANDA definition appropriate. Judgment of both groups of nurses was equivanent (p= .93). Experts classified 8 (11%) defining characteristics as critical, but only 2 (3%)—anxious, fidgeting—were judged critical by both expert nurses and clinicians. Two defining characteristics (increased tension, preoccupation) of the 8 had statistically different scores between the two groups. The other defining characteristics were statistically similar. A total DCV score of 0.67 ± 0.10 was obtained from expert nurses and 0.65 ± 0.10 from clinicians (nonsignificant).DISCUSSION Anxiety is a common and frequent manifestation and a nursing concept identified and recognized by Brazilian nurses who considered it clearly defined and established by NANDA. Both groups of Brazilian nurses judged signs and symptoms of anxiety in a very similar way.CONCLUSIONSAccording to Brazilian nurse experts, anxiety is well understood and in their view there are 8 critical defining characteristics (anxious, fidgeting, jittery, increased tension, insomnia, irritability, preoccupation, sleep disturbance) and 38 noncritical defining characteristics. The other characteristics (24) were not judged to be relevant. Further research is necessary to conduct validation studies of other nursing diagnoses and other components of nursing practice in Brazil. Such initiatives certainly will contribute the efforts of NANDA/NIC/NOC to standardize languages for nursing, decrease cultural differences, and enlarge and enrich nursing knowledge.

Validity Surveys: Selected NOC Physiologic Outcomes

PURPOSE To measure and provide evidence supporting the use of NOC as a nursing standardized language. METHODS Initially, the group used nursing resources and concept analyses to determine physiologic outcomes important to nursing care and demonstrate contributions of nurses to patient care. After refinement by the NOC team, outcome and indicators were approved and content validity surveys sent to members of the American Association of Nephrology Nurses. A modified Fehring's Diagnostic Content Validity Model was used to determine validity. Respondents used a 5-point Likert-type scale. Each indicator was rated and a weight assigned, and a mean for each indicator was determined. Results of the importance and contribution scores were interpreted using ≥.80 to indicate a “critical” indicator, and ≥.60 to indicate “important” indicators. FINDINGS There were 59 total responses with 45 valid cases. The nurses had worked an average of 21.4 years. Twenty-five of the nurses were involved in implementing standardized language, including care-planning systems. The majority, 95%, held master's degrees in nursing and 82.2% were certified. All results were analyzed for both contribution and importance using the established method to determine critical and important indicators in both categories. Hydration: 13 indicators analyzed. ▪ Contribution: No critical indicators; 11 were rated important (range: 60–77). ▪ Importance: 8 indicators rated critical. The 4 highest were shortness of breath not present (.90), blood pressure within normal limits (.89), peripheral edema not present (.88), and adventitious breath sounds not present (.88). Five were rated important (range: 69–78). Urinary Incontinence: 19 indicators analyzed. ▪ Contribution: No critical indicators; 9 were rated important (range: 61–74). ▪ Importance: 5 indicators were rated critical, the 3 highest being recognizes urge to void (.88), absence of urinary tract infection (.86), and absence of postvoid residual (.85) (range: 67–88). Dialysis Access Integrity: 15 indicators analyzed. ▪ Contribution: 3 were rated critical: drainage at site not present (.83), hematoma at site not present (.82), and bleeding at site not present (.81). There were 11 important indicators (range: 60–78). ▪ Importance: 7 were rated critical, the 3 highest being bruit (.97), thrill (.95), and drainage at site not present (.95). Seven were rated as important (range: 64–77). Systemic Toxin Clearance–Dialysis: 14 indicators analyzed. ▪ Contribution: No critical indicators and 12 important indicators (range: 60–78). ▪ Importance: 5 were rated critical, the top 3 being adheres to dialysis schedule (.95), urea reduction ratio (.95), and blood potassium within normal limits (.88). Nine were rated important (range: 63–77). DISCUSSION Based on these results, the indicators are representative of the outcomes. Analyses of the indicators supported an overall level of agreement. The highest averages were in two outcomes related to patients undergoing dialysis, which may be because the nurses cared for a specific target group. CONCLUSIONS The importance of indicators was rated more highly than the nursing contribution. Most of the indicators were judged quite or very important. The outcomes are nursing sensitive, and nursing is more influential than other disciplines for most of the outcomes.

Clinical validation of the related factors and defining characteristics of impaired swallowing for patients with stroke.

This exploratory study was conducted to examine the reliability and validity of related factors and defining characteristics of impaired swallowing for stroke patients. Sample of the study included (1) 12 nursing experts, (2) 52 nurses who work in neurological wards, and (3) 107 stroke patients who were divided into a BDST (Burks Dysphagia Screening Test)-positive group (n = 51) and a BDST-negative group (n = 56). Data were collected and validated based on expert validity, diagnostic content validity (DCV), construct validity, and discriminate validity. Results showed that the DCV scores of 17 related factors and 12 defining characteristics were all greater than 0.5. The internal consistency of the 12 defining characteristics was demonstrated by a Cronbach alpha coefficient of 0.89. Two factors were extracted from the 12 defining characteristics after factor analysis; these were "high risk of aspiration with speech disorder" and "ineffectiveness of swallowing". Five major defining characteristics, i.e. pocketing of food, signs of acute aspiration, burning or tickling at the back of the throat, spitting food or food leaking from the mouth, and weak or hoarse cough, were determined by logistic regression. The findings of this study suggest that the 17 related factors and 12 defining characteristics are reliable and valid in diagnosing the problem of impaired swallowing for stroke patients.

Validation of the defining characteristics of body image disturbance in Japan.

To examine the validity of the nursing diagnosis body image disturbance and to specify its major and minor defining characteristics in Japanese culture. A qualified sample of 149 RNs with an average of 10 years of clinical experience and knowledge of nursing diagnosis was given a questionnaire consisting of 21 defining characteristics from NANDA, 8 additional items from the literature, and 2 distracting characteristics. Four major diagnostic content validation (DCV) scores of 0.75 and higher and 15 minor defining characteristics with DCV scores from 0.60 to 0.74 were identified. This study provides a foundation for further study of culturally appropriate defining characteristics for use in Japan.

Validation study for impaired personal boundaries, proposed nursing diagnosis.

The authors propose a new nursing diagnosis of impaired personal boundaries based on their experience in psychiatric nursing, a concept analysis of the literature and diagnostic content validation by a panel of experts. Impaired personal boundaries are common in a number of mental disorders including, schizophrenia, borderline personality, substance abuse and enabling. Recognition of this patient problem has implications for further research and nursing interventions.

Validation of the defining characteristics of the nursing diagnosis ineffective airway clearance.

The investigators designed this validation study to determine the defining characteristics of the nursing diagnosis ineffective airway clearance. Using Fehring's Diagnostic Content Validity Model, 546 nurses who care for respiratory clients validated one major and 19 minor defining characteristics. Nine characteristics previously described in the literature were eliminated. Clarification of the defining characteristics of this diagnosis improves communication in practice, education and research.

Validating gender-specific defining characteristics of altered sexuality.

The authors conducted a retrospective study to validate gender-specific defining characteristics for the proposed nursing diagnosis altered sexuality. An investigator-designed tool was used to collect data from 100 randomly selected members of NANDA. The Fehring method of diagnostic content validity was used to identify major and minor defining characteristics for men and women. The defining characteristics identified and validated encompass all dimensions of human sexuality, and are more concise and descriptive of this human response than those currently in use. Findings of this study will be used to develop a tool for assessment of altered sexuality in a variety of populations and settings.

Validation of cutaneous stimulation interventions for pain management

The purpose of this study was to identify and validate specific activities considered important in the implementation of selected cutaneous stimulation pain management interventions including heat and cold application, massage and Transcutaneous Electrical Nerve Stimulation (TENS). A two-round Delphi survey was completed by nurses selected for their expertise in pain management. Data were analyzed using a modification of Fehring's diagnostic content validity method. Consistently high scores were obtained by the raters for each intervention and activity, with most activities perceived as critical to the intervention. From this process, a list of activities for each cutaneous stimulation intervention evolved that are applicable to education, clinical practice and clinical nursing research.

Validation of the defining characteristics of potential for violence.

A high incidence of violence occurs in contemporary society, which is reflected in the violence exhibited by psychiatric patients. To validate the defining characteristics of potential for violence, 125 registered nurses were asked to rate the relevance of defining characteristics of the diagnosis. A diagnostic content validity index was used to ascertain which defining characteristics the nurses believed to be the most critical in the identification of violence potential. Nine major and 20 minor characteristics were identified by these nurses.