Teoria de situação específica e análise de conteúdo do diagnóstico de enfermagem nutrição desequilibrada: menor do que as necessidades corporais em crianças com câncer

Abstract

The safe use of nursing diagnoses in clinical practice requires them to be trusted, highlighting the importance of diagnostic validation for review and try them. Thus, the aim of this study was to develop two phases of diagnostic validation to achieve the evidence of theoretical and content validity of nursing diagnosis Imbalanced nutrition: less than body requirements in children with cancer. These phases included the development of Situational Specific Theory (SST) and the content analysis for judges. The first phase, development between April of 2017 to July of 2018, was based on pre-existing of nursing diagnosis in a study contained in the NANDA International taxonomy, in the subcomponent Nutrition described in Roy’s Adaptation Model, and in the literature review. The first phase happened according to the following steps: approach definition to building SST, conceptual models’ definitions to be analyzed, key-concepts definitions, development of pictogram, development of propositions, and causal relations between the elements and practice evidence. New essentials attributes were identified. From that, 26 antecedents’ clinical factors (ACF) and 22 consequents’ clinical factors (CCF) were identified, building conceptual and empirical definitions. The cause-effect pictogram was development after the analysis of these elements. Additionally, ten propositions were made, and causal effects were established. Thus, a considerable difference between elements of SST and NANDA-I was verified. In NANDA-I the diagnosis definition is restricted to the Ingestion stage, has only seven ACF, and the 22 CCF were different. The second phase was content validity by judges and aiming to verify the appropriateness of the diagnostic label, the relevance of ACF and CCF for diagnosis, and the clarity and precision of conceptual and empirical definitions. For this phase, the Predictive diversity theorem was used. 23 judges were selected, in based on practice and academic experience, and they were classified in five levels of expertise. The data collection was between February and June of 2019. The pseudo-median was used weighted by the level of judges’ expertise, adopting 0.9 for the Content Validation Index as a cutoff point. Regarding the adequacy of the new diagnostic label, 78.26% of the judges judged the label and definition listed for SST to be more appropriate. Of the 22 CCF analyzed, five were not considered relevant, they are: Apathy; Edema of lower limbs; Petechiae, purples or bruises; Fracture; and Poor Perceptual Organization. The CCF Dry and brittle hair and Pale mucous membranes did not show, respectively, precision of conceptual definition and precision of operational definition. Regarding the ACF, one factor was not submitted to analysis, thus, of the 25 analyzed, four were not considered relevant, they are: Non-acceptance of the disease, 11 Loneliness, Disturbed interpersonal relationships and Dysgeusia. The latter, it is recommended to keep it due to evidence in robust studies. The conceptual definitions for Nausea/vomiting and Inadequate eating pattern did not present, respectively, clarity and precision. Regarding the operational definitions of the ACF Anorexia and Nausea / vomiting were not accurate. The 17 CCF deemed relevant had high CVI-G, moderate agreement between judges and high internal consistency. This also happened to the 21 ACF deemed relevant. Therefore, changes were made to the definitions as suggested by the judges. It is concluded that, according to the methods employed, the present study provided the refinement and improvement of the components of Imbalanced nutrition: less than body requirements in the population of children with cancer, composed, until this stage, by new essential attributes, 22 ACF and 17 CCF. Thus, it helps to identify the presence of the diagnosis in that population with more precision.